How reliable are ADC measurements? A phantom and clinical study of cervical lymph nodes

Moreau, Bastien; Iannessi, Antoine; Hoog, Christopher; Beaumont, Hubert

doi:10.1007/s00330-017-5265-2

Cited by 31 publications

(39 citation statements)

References 42 publications

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“…Our result for interobserver reproducibility of ADC measurements for lymph nodes in children and adolescents with Hodgkin lymphoma emulates previous findings for nodal ADC reproducibility in healthy volunteers [25, 26]. Moreau et al [26] found that the inter-reader reproducibility for their ADC measurements showed an absolute bias of 0.045×10 −3 mm 2 s −1 (level of agreement −0.146; 0.056).…”

Section: Discussionsupporting

confidence: 88%

“…Moreau et al [26] found that the inter-reader reproducibility for their ADC measurements showed an absolute bias of 0.045×10 −3 mm 2 s −1 (level of agreement −0.146; 0.056). Although both studies used a different protocol compared to our study, they highlighted that ADC measurement in healthy volunteers might not always be adequately reproducible and that a reliable use of ADC values requires further technical advances and systematic quality control [25, 26].…”

Section: Discussionmentioning

confidence: 99%

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Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

et al. 2019

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Background Whole-body MRI is used for staging paediatric Hodgkin lymphoma, commonly using size thresholds, which fail to detect disease in normal-size lymph nodes. Objective To investigate quantitative whole-body MRI metrics for nodal characterisation. Materials and methods Thirty-seven children with Hodgkin lymphoma underwent 1.5-tesla (T) whole-body MRI using short tau inversion recovery (STIR) half-Fourier-acquisition single-shot turbo-spin-echo and diffusion-weighted imaging (DWI). 18 Flourine-2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET)/CT was acquired as the reference standard. Two independent readers assessed 11 nodal sites. The readers measured short-axis-diameter, apparent diffusion coefficient, (ADC) and normalised T2-signal intensity of the largest lymph node at each site. We used receiver operating characteristics (ROC)/area-under-the-curve (AUC) analysis for each MRI metric and derived sensitivity and specificity for nodes with short-axis diameter ≥10 mm. Sub-analysis of sensitivity and specificity was performed with application of ADC cut-off values (<0.77, <1.15 and <1.79×10 −3 mm 2 s −1 ) to 5- to 9-mm nodes. Results ROC/AUC values for reader 1/reader 2 were 0.80/0.80 and 0.81/0.81 for short-axis-diameter measured using DWI and STIR half-Fourier-acquisition single-shot turbo spin echo, respectively; 0.67/0.72 for normalised T2 signal intensity and 0.74/0.67 for ADC. Sensitivity and specificity for a short-axis diameter ≥10 mm were 84.2% and 66.7% for Reader 1 and 82.9% and 68.9% for Reader 2. Applying a short-axis-diameter ≥10-mm threshold followed by ADC cut-offs to normal-size 5- to 9-mm nodes resulted in sensitivity and specificity for Reader 1 of 88.8% and 60%, 92.1% and 56.7%, and 100% and 16.7%; and for Reader 2, 86.1% and 67.2%, 95.3% and 65.6%, and 100% and 19.7%; and ADC thresholds of <0.77, <1.15, and <1.79×10 −3 mm 2 s −1 , respectively. Conclusion Nodal size measurement provides the best single classifier for nodal disease status in paediatric Hodgkin lymphoma. Combined short-axis diameter and ADC thresholds marginally improve sensitivity and drop specificity compared with size classification alone.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

et al. 2019

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“…Thirdly, we did not analyze a possible influence of some technical details, such as sequence type, choice of b values, and Tesla strength. The following aspect should also be addressed: Previously, some authors indicated that ADC values depended significantly on ADC measurements (39,40). It has been shown that different drawing methods, for example, whole tumor measurements, choice of multiple regions of interest, and/or single region measure, can influence ADC values (39,40).…”

Section: Discussionmentioning

confidence: 99%

Apparent Diffusion Coefficient for Distinguishing Between Malignant and Benign Lesions in the Head and Neck Region: A Systematic Review and Meta-Analysis

Surov¹,

Wienke

2020

Front. Oncol.

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Background: The purpose of the present meta-analysis was to provide evident data about use of apparent diffusion coefficient (ADC) values for distinguishing malignant and benign lesions in the head and neck region. Material and Methods: MEDLINE and Scopus databases were screened for associations between ADC and malignancy/benignancy of head and neck lesions up to December 2018. Overall, 22 studies met the inclusion criteria. The following data were extracted: authors, year of publication, study design, number of patients/lesions, lesion type, mean value, and standard deviation of ADC. The primary endpoint of the systematic review was the analysis of the association between lesion nature and ADC values. The methodological quality of the involved studies was checked according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malignant lesions. Results: The acquired 22 studies comprised 1,227 lesions. Different malignant lesions were diagnosed in 818 cases (66.7%) and benign lesions in 409 cases (33.3%). The mean ADC value of the malignant lesions was 1.04 × 10 −3 mm 2 /s, and the mean value of the benign lesions was 1.46 × 10 −3 mm 2 /s. Lymphomas and sarcomas showed the lowest calculated mean ADC values, 0.7 and 0.79 × 10 −3 mm 2 /s, respectively. Adenoid cystic carcinomas had the highest ADC values (1.5 × 10 −3 mm 2 /s). None of the analyzed malignant tumors had mean ADC values above 1.75 × 10 −3 mm 2 /s. Conclusion: ADC values play a limited role in distinguishing between malignant and benign lesions in the head and neck region. It may be only suggested that lesions with mean ADC values above 1.75 × 10 −3 mm 2 /s are probably benign. Further large studies are needed for the analysis of the role of diffusion-weighted imaging (DWI)/ADC in the discrimination of benign and malignant lesions in the head and neck region.

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“…However, there are weighty problems with repeatability and reproducibility of ADC measurements between different MR units and centers, as well as various protocols, different acquisition and analysis methodologies are being used, which are only at the beginning to be challenged, especially for the whole-body imaging [21][22][23][24][25]. There are neither generalized quality controls nor standardization of ADC measurements, yet [10].…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of a mean ADC value was performed on an ADC map, around the reference point set on DWI b = 0 map, by drawing a possibly smallest region of interest confined within the anatomical limits of a ganglion or a lymph node (on DWI b = 0 map with reference to T2-weighted images) to avoid a partial volume effect, as recommended by Moreau et al [10].…”

Section: Methodsmentioning

confidence: 99%

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

Białek¹,

Małkowski

2020

Nuklearmedizin

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Aim To check if diffusion weighted imaging (DWI) might be helpful in proper recognition of celiac (CG) and cervicothoracic (CTG) sympathetic ganglia on the whole-body multimodal PSMA-ligand PET/MR imaging, in the view of their common misleading avidity on PET potentially suggestive of malignant lesions, including metastatic lymph nodes. Methods The thickness and the level of diffusion restriction was assessed qualitatively and quantitatively in 406 sympathetic ganglia (189 CTG in 101 males and 217 CG in 116 males) on DWI maps (b-value 0 and 800 s/mm2) and apparent diffusion coefficient (ADC) maps (mean ADC) of the whole-body PET/MR 68Ga-PSMA-11 PET/MR. To form a reference group of a matching ganglia size, the smallest lymph node was chosen from each patient with metastases and underwent the same procedure. Results Very low and low level of diffusion restriction was noted in the majority of sympathetic ganglia (81.0 % CTG, 67.3 % CG, and 73.6 % of all). In the majority (91.7 %) of metastatic lymph nodes the level of diffusion restriction was moderate to high.The mean ADC values in sympathetic ganglia were statistically significantly higher in CTG, CG and all ganglia than in metastatic lymph nodes (p < 0.001; the effect size was large). Conclusions Sympathetic celiac and cervicothoracic ganglia present very low and low level of diffusion restriction in visual DWI assessment, and significantly higher than metastatic lymph nodes mean ADC values in the majority of cases, which may serve as additional factors aiding differential diagnosis on multimodal PSMA-ligand PET/MR imaging.Therefore, PSMA-ligand PET/MR appears potentially superior to PSMA-ligand PET/CT in proper identification of sympathetic ganglia.

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How reliable are ADC measurements? A phantom and clinical study of cervical lymph nodes

Cited by 31 publications

References 42 publications

Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

Whole-body magnetic resonance imaging in paediatric Hodgkin lymphoma — evaluation of quantitative magnetic resonance metrics for nodal staging

Apparent Diffusion Coefficient for Distinguishing Between Malignant and Benign Lesions in the Head and Neck Region: A Systematic Review and Meta-Analysis

Is the level of diffusion restriction in celiac and cervico-thoracic sympathetic ganglia helpful in their proper recognition on PSMA ligand PET/MR?

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