Metastases in Normal-sized Pelvic Lymph Nodes: Detection with Diffusion-weighted MR Imaging
Metastases in Normal-sized Pelvic Lymph Nodes: Detection with Diffusion-weighted MR Imaging
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DOI：
10.1148/radiol.14132921
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发表时间：
2014-10-01
期刊：
影响因子：
19.7
通讯作者：
Studer, Urs E.
中科院分区：
文献类型：
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作者：
Thoeny, Harriet C.;Froehlich, Johannes M.;Studer, Urs E.
目的：前瞻性评价弥散加权（DW）磁共振（MR）成像对分期为N0期前列腺癌和/或膀胱癌患者盆腔淋巴结转移的诊断价值。材料和方法：本研究经独立伦理委员会批准。所有患者均获得书面知情同意。术前横断图像上淋巴结未肿大的患者计划行原发肿瘤根治性切除和扩大盆腔淋巴结清扫。所有患者均接受3-T MR检查，检查包括整个骨盆的常规和DW MR成像。图像分析由三名独立的阅读者进行，不了解任何临床信息。根据高b值DW MR图像的高信号强度和形态学特征（形状、边界）诊断转移。以组织病理学检查为参照标准。计算灵敏度和特异性，并使用bootstrap方法获得偏差校正的95%置信区间（ci）。采用Fleiss和Cohen k检验及中位数检验进行统计分析。结果：120例患者共切除4846个淋巴结。120例患者中有33例（27.5%）发现88例淋巴结转移。这些转移瘤的短轴直径小于或等于3mm者68例，大于3mm至5mm者13例，大于5mm至8mm者5例；两段长度超过8毫米。在每个患者的水平上，在33例转移患者中，三个阅读器正确检测转移26例（79%;95% CI: 64%, 91%）， 21例（64%;95% CI: 45%, 79%）和25例（76%;95% CI: 60%, 90%），各自的特异性为85% (95% CI: 78%, 92%), 79% （95% CI: 70%, 88%）和84% （95% CI: 76%, 92%）。根据半骨盆分析，240例盆腔中有44例（18%）经组织病理学检查发现淋巴结转移；在44例DW MR图像中，三名读卡器正确检测出26例（59%;95% CI: 45%, 73%）， 19例（43%;95% CI: 27%, 57%）和28例（64%;95% CI: 47%, 78%）。结论：DW MR成像能够无创地发现相当比例的前列腺癌和膀胱癌患者正常淋巴结的小淋巴结转移，常规横断面成像技术诊断为N0。(c) rsna, 2014
Purpose: To prospectively assess the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging in the detection of pelvic lymph node metastases in patients with prostate and/or bladder cancer staged as N0 with preoperative cross-sectional imaging.Materials and Methods: This study was approved by an independent ethics committee. Written informed consent was obtained from all patients. Patients with no enlarged lymph nodes on preoperative cross-sectional images who were scheduled for radical resection of the primary tumor and extended pelvic lymph node dissection were enrolled. All patients were examined with a 3-T MR unit, and examinations included conventional and DW MR imaging of the entire pelvis. Image analysis was performed by three independent readers blinded to any clinical information. Metastases were diagnosed on the basis of high signal intensity on high b value DW MR images and morphologic features (shape, border). Histopathologic examination served as the standard of reference. Sensitivity and specificity were calculated, and bias-corrected 95% confidence intervals (CIs) were obtained with the bootstrap method. The Fleiss and Cohen k and median test were applied for statistical analyses.Results: A total of 4846 lymph nodes were resected in 120 patients. Eighty-eight lymph node metastases were found in 33 of 120 patients (27.5%). Short-axis diameter of these metastases was less than or equal to 3 mm in 68, more than 3 mm to 5 mm in 13, more than 5 mm to 8 mm in five; and more than 8 mm in two. On a per-patient level, the three readers correctly detected metastases in 26 (79%; 95% CI: 64%, 91%), 21 (64%; 95% CI: 45%, 79%), and 25 (76%; 95% CI: 60%, 90%) of the 33 patients with metastases, with respective specificities of 85% (95% CI: 78%, 92%), 79% (95% CI: 70%, 88%), and 84% (95% CI: 76%, 92%). Analyzed according to hemipelvis, lymph node metastases were detected with histopathologic examination in 44 of 240 pelvic sides (18%); the three readers correctly detected these on DW MR images in 26 (59%; 95% CI: 45%, 73%), 19 (43%; 95% CI: 27%, 57%), and 28 (64%; 95% CI: 47%, 78%) of the 44 cases.Conclusion: DW MR imaging enables noninvasive detection of small lymph node metastases in normal-sized nodes in a substantial percentage of patients with prostate and bladder cancer diagnosed as N0 with conventional cross-sectional imaging techniques. (C) RSNA, 2014