Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma
Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma
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DOI：
10.1007/s00234-008-0487-2
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发表时间：
2009-03-01
期刊：
影响因子：
2.8
通讯作者：
Beets-Tan, R. G. H.
中科院分区：
文献类型：
--
作者：
de Bondt, R. B. J.;Hoeberigs, M. C.;Beets-Tan, R. G. H.
目的是确定扩散加权成像在头颈部鳞状细胞癌恶性淋巴结检测中的诊断准确性和附加价值，在1.5 T下对16例连续患者的219个淋巴结（主要小于10 mm（95.4%））进行了评估。评价淋巴结的最大短轴径、形态学标准和表观扩散系数（ADC）值（B = 0和B = 1，000 s/mm（2））。分别和联合计算各种磁共振成像（MRI）标准的敏感性、特异性、阳性和阴性预测值以及诊断比值比（DORs）和ROC曲线曲线下面积（AUC）。颈淋巴结的组织学检查是判断恶性病变的金标准，最佳ADC阈值为1.0 × 10 - 3 mm 2/s。使用此临界点，敏感性和特异性分别为92.3%和83.9%。结合肿瘤大小和形态学标准，ADC值< 1.0 x 10（-3）mm（2）/s是预测肿瘤转移的最佳指标（DOR = 97.6）。将ADC值添加到其他MRI标准的模型比没有ADC值的模型表现得更好：AUC = 0.98对AUC = 0.91（p = 0.036）。在这项研究中，主要是小淋巴结，ADC标准是存在转移的最强独立预测因子。结合其他MRI标准使用ADC值可显著提高良恶性淋巴结的鉴别能力。
The aim was to determine the diagnostic accuracy and additional value of diffusion-weighted imaging for detection of malignant lymph nodes in head and neck squamous cell carcinoma.Two hundred nineteen lymph nodes, predominantly smaller than 10 mm (95.4%), in 16 consecutive patients were evaluated at 1.5 T. Lymph nodes were evaluated for maximum short axial diameter, morphological criteria, and apparent diffusion coefficient (ADC) values (b = 0 and b = 1,000 s/mm(2)). Sensitivity, specificity, positive and negative predictive values as well as diagnostic odds ratios (DORs) and areas under the curves (AUCs) of ROC curves were calculated for the various magnetic resonance imaging (MRI) criteria individually and in combination. Histological examination of lymph nodes in the neck dissection specimen was the gold standard to determine malignant involvement.The optimal ADC threshold was 1.0 x 10(-3) mm(2)/s. Using this cutoff point, sensitivity and specificity were 92.3% and 83.9%, respectively. When used in combination with size and morphological criteria, ADC value < 1.0 x 10(-3) mm(2)/s was the strongest predictor of presence of metastasis (DOR = 97.6). A model which added ADC values to the other MRI criteria performed significantly better than a model without ADC values: AUC = 0.98 versus AUC = 0.91 (p = 0.036).In this study, with predominantly small lymph nodes, the ADC criterion is the strongest independent predictor of presence of metastasis. The use of ADC values in combination with the other MRI criteria significantly improves the discrimination between malignant and benign lymph nodes.