Advantages of Diffusion-Weighted Imaging Over Positron Emission Tomography-Computed Tomography in Assessment of Hilar and Mediastinal Lymph Node in Lung Cancer
Advantages of Diffusion-Weighted Imaging Over Positron Emission Tomography-Computed Tomography in Assessment of Hilar and Mediastinal Lymph Node in Lung Cancer
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DOI：
10.1245/s10434-012-2799-z
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发表时间：
2013-05-01
影响因子：
3.7
通讯作者：
Sakuma, Tsutomu
中科院分区：
文献类型：
--
作者：
Usuda, Katsuo;Sagawa, Motoyasu;Sakuma, Tsutomu
弥散加权成像（DWI）对结节累及的诊断意义尚不确定。本研究的目的是比较DWI与PET-CT对肺癌淋巴结累及的诊断能力。本研究共分析了160例肺癌（114例腺癌，36例鳞状细胞癌和10例其他细胞类型）。术前行DWI、PET-CT检查。诊断转移性淋巴结的最佳临界值ADC值为1.70 × 10(-3) mm(2)/s， SUVmax为4.45。DWI正确诊断N分期144例（90%），错误诊断N分期16例（10%）[3例（1.9%）为分期过期，13例（8.1%）为分期不足]。PET-CT正确诊断N分期133例（83.1%），错误诊断N分期27例（16.8%）[4例（2.5%）为分期过期，23例（14.4%）为分期不足]。DWI对N分期的敏感性、准确性和阴性预测值均显著高于PET-CT。在检查的705个淋巴结中，61个有转移，644个没有。DWI和PET-CT均未检出的21个淋巴结转移灶最大直径为3.0 +/- A 0.9 mm， DWI检出的39个淋巴结转移灶最大直径为7.2 +/- A 4.1 mm， PET-CT检出的24个淋巴结转移灶最大直径为11.9 +/- A 4.1 mm。他们之间存在显著差异。DWI对淋巴结转移灶的敏感性（63.9%）明显高于PET-CT（39.3%）。DWI对所有淋巴结的准确率（96.2%）明显高于PET-CT的准确率（94.3%）。DWI对肺癌良性淋巴结的恶性诊断优于PET-CT。
The significance of diffusion-weighted imaging (DWI) is uncertain for the diagnosis of nodal involvement. The purpose of this study was to examine diagnostic capability of DWI compared with PET-CT for nodal involvement of lung cancer.A total of 160 lung cancers (114 adenocarcinomas, 36 squamous cell carcinomas, and 10 other cell types) were analyzed in this study. DWI and PET-CT were performed preoperatively.The optimal cutoff values to diagnose metastatic lymph nodes were 1.70 x 10(-3) mm(2)/s for ADC value and 4.45 for SUVmax. DWI correctly diagnosed N staging in 144 carcinomas (90 %) but incorrectly diagnosed N staging in 16 (10 %) [3 (1.9 %) had overstaging, 13 (8.1 %) had understaging]. PET-CT correctly diagnosed N staging in 133 carcinomas (83.1 %) but incorrectly diagnosed N staging in 27 (16.8 %) [4 (2.5 %) had overstaging, 23 (14.4 %) had understaging]. Sensitivity, accuracy, and negative predictive value for N staging by DWI were significantly higher than those by PET-CT. Of the 705 lymph node stations examined, 61 had metastases, and 644 did not. The maximum diameter of metastatic lesions in lymph nodes were 3.0 +/- A 0.9 mm in 21 lymph node stations not detected by either DWI or PET-CT: 7.2 +/- A 4.1 mm in 39 detected by DWI, and 11.9 +/- A 4.1 mm in 24 detected by PET-CT. There were significant differences among them. The sensitivity (63.9 %) for metastatic lymph node stations by DWI was significantly higher than that (39.3 %) by PET-CT. The accuracy (96.2 %) for all lymph node stations by DWI was significantly higher than that (94.3 %) by PET-CT.DWI has advantages over PET-CT in diagnosing malignant from benign lymph nodes of lung cancers.