Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Yasui, Ouki; Sato, Makoto; Kamada, Atsushi

doi:10.1620/tjem.218.177

Cited by 50 publications

(40 citation statements)

References 26 publications

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“…With respect to ADC for LNs, our results showed that the mean ADC of metastatic LNs was significantly lower than that of nonmetastatic LNs and this concurs with the results of previous human studies (14,15,22). Yasui et al (22) (15) explained that the overlap between the ADC values of metastatic and nonmetastatic LNs was caused by external factors, such as the MR acquisition parameters and magnetic fields used as well as the inherent limitation of ADC.…”

Section: Discussionsupporting

confidence: 91%

“…Yasui et al (22) (15) explained that the overlap between the ADC values of metastatic and nonmetastatic LNs was caused by external factors, such as the MR acquisition parameters and magnetic fields used as well as the inherent limitation of ADC. With respect to the relatively poor interobserver agreement, in our opinion it could be attributed to the small LNs (less than 5 mm).…”

Section: Discussionmentioning

confidence: 99%

“…DWI has recently drawn much attention as a functional imaging modality for a variety of oncologic applications, including tumor detection and characterization (19)(20)(21)(22). Several investigators have reported promising results using apparent diffusion coefficient (ADC) to identify metastatic LNs in head and neck cancer (12,13) and in uterine cervical cancer (14,15).…”

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confidence: 99%

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Evaluation of lymph node metastases: Comparison of gadofluorine M‐enhanced MRI and diffusion‐weighted MRI in a rabbit VX2 rectal cancer model

Kim

Lee

Moon

et al. 2012

Magnetic Resonance Imaging

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Purpose: To compare the diagnostic performance of a diffusion-weighted imaging (DWI) dataset and a gadofluorine M-enhanced imaging dataset for identifying lymph node (LN) metastases in a rabbit rectal cancer model. Materials and Methods:VX2 carcinomas were injected into the rectum of 26 rabbits. Four weeks later, T2-weighted imaging (T2WI), pre-T1WI, DWI, and post-T1WI were performed. Two radiologists independently reviewed the DWI set (T2WI, pre-T1WI, DWI) and the gadofluorine M set (T2WI, pre-and post-T1WI) and recorded their confidence scores for LN metastasis on a per-LN basis. Receiver operating characteristic (ROC) analysis was performed to compare the area under the ROC curve (A z ) of the two imaging sets. Histopathologic results were used as the reference standard.Results: The A z and sensitivity of the gadofluorine M set were comparable to those of the DWI set (A z , for reader 1, 0.849, 0.829, P ¼ 0.571; for reader 2, 0.923, 0.876, P ¼ 0.212; sensitivity, for reader 1, 97%, 97%; for reader 2, 97%, 92%, P ¼ 0.304). The specificity of the former was greater than that of the latter (for reader 1, 65%, 53%, P ¼ 0.0003; for reader 2, 81%, 68%, P ¼ 0.01).Conclusion: Gadofluorine M-enhanced images provided greater specificity than DWI for identifying LN metastases, whereas the A z and sensitivity of the former were comparable to those of the latter. COLORECTAL CANCER is the third most common cancer and the third leading cause of cancer-related death in the United States, with a 5-year survival rate reported to be %66% (1). In its treatment, neoadjuvant chemoradiation therapy (CRT) has been considered the standard of care for locally advanced rectal cancer (!T3 stage, which is defined as tumor invades through the rectal wall into perirectal soft tissues or lymph node [LN] metastasis), since several investigators demonstrated that neoadjuvant CRT was able to significantly decrease the local recurrence rate (2,3). As LN metastasis has been singled out to be an important prognostic factor related to disease-free survival and to the local recurrence rate (4), accurate preoperative diagnosis of LN metastasis in patients with rectal cancer is crucial not only for obtaining the optimal prognosis but also for appropriate selection of patients who will derive the most benefit from neoadjuvant CRT. However, although magnetic resonance imaging (MRI) is an excellent diagnostic tool for tumor-staging due to its excellent soft-tissue contrast and ability to depict all mesorectal structures (5-7), its accuracy for LN-staging has been reported to be in the range of 43%-85% (6-8). This wide range of accuracy and relatively poor sensitivity of 66% suggest that the MR criterion for the detection of LN metastases, ie, LN size, is not a reliable discriminator for metastatic LNs (8-11). Although several attempts have been made to increase the poor sensitivity of MR for LN metastases by adding morphologic criteria such as border and internal signal intensity (11), these morphologic criteria seem to have intrinsic limitations in sma...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Evaluation of lymph node metastases: Comparison of gadofluorine M‐enhanced MRI and diffusion‐weighted MRI in a rabbit VX2 rectal cancer model

Kim

Lee

Moon

et al. 2012

Magnetic Resonance Imaging

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“…However, these studies [10][11][12][13][14][15] exclusively investigated pathologic lymph nodes with different histologies and did not compare ADCs of lymphomatous lymph nodes to those of normal lymph nodes. Furthermore, although some studies [16][17][18][19][20][21] have shown that ADCs of metastatic lymph nodes are significantly different from those of normal lymph nodes, these studies did not include lymphomatous lymph nodes. Moreover, results of different studies are generally not comparable due to the use of different b-values, a different number of b-values, and different ADC measurement methods.…”

Section: Introductionmentioning

confidence: 99%

ADC measurements in the evaluation of lymph nodes in patients with non-Hodgkin lymphoma: feasibility study

Kwee

Ludwig

Uiterwaal

et al. 2010

Magn Reson Mater Phy

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Object To determine whether apparent diffusion coefficient (ADC) measurements allow discrimination of normal lymph nodes from lymphomatous lymph nodes, and indolent lymphomas from aggressive lymphomas in patients with nonHodgkin lymphoma (NHL). Materials and methods Eighteen healthy volunteers and thirty-two patients with newly diagnosed NHL (indolent: n = 16; aggressive: n = 16) underwent diffusion-weighted imaging. ADCs of normal lymph nodes were compared to those of lymphomatous lymph nodes, and ADCs of indolent lymphomas were compared to those of aggressive lymphomas. Receiver operating characteristic (ROC) analysis was Results ADCs (in 10 −3 mm 2 /s) of lymphomatous lymph nodes (0.70 ± 0.22) were significantly lower (P < 0.0001) than those of normal lymph nodes (1.00 ± 0.15). Area under the ROC curve was 0.865. Sensitivity and specificity were 78.1 and 100% when using an optimal cutoff ADC value of 0.80. On the other hand, ADCs of indolent lymphomas (0.67 ± 0.21) were not significantly different (P = 0.2997) from those of aggressive lymphomas (0.74 ± 0.23). Conclusion ADC measurements show promise as a highly specific tool for the discrimination of normal lymph nodes from lymphomatous lymph nodes, but appear to be of no utility in differentiating indolent from aggressive lymphomas.

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“…6 The value of quantitative DWI in the characterization of lymph nodes is still unclear. The apparent diffusion coeffi cient (ADC) of metastatic lymph nodes has been reported to be signifi cantly different from those of nonmetastatic lymph nodes in numerous studies, [7][8][9][10][11][12][13][14] but the considerable overlap in ADCs between the groups may be an issue. Furthermore, other studies even reported the difference in ADCs between the groups to be nonsignifi cant.…”

Section: Introductionmentioning

confidence: 99%

Diffusion magnetic resonance imaging with gadofosveset trisodium as a negative contrast agent for lymph node metastases assessment

et al. 2011

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Diffusion-Weighted Imaging in the Detection of Lymph Node Metastasis in Colorectal Cancer

Cited by 50 publications

References 26 publications

Evaluation of lymph node metastases: Comparison of gadofluorine M‐enhanced MRI and diffusion‐weighted MRI in a rabbit VX2 rectal cancer model

Evaluation of lymph node metastases: Comparison of gadofluorine M‐enhanced MRI and diffusion‐weighted MRI in a rabbit VX2 rectal cancer model

ADC measurements in the evaluation of lymph nodes in patients with non-Hodgkin lymphoma: feasibility study

Diffusion magnetic resonance imaging with gadofosveset trisodium as a negative contrast agent for lymph node metastases assessment

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