Role of diffusion-weighted MR imaging in cervical lymphadenopathy

Abstract

The role of diffusion-weighted magnetic resonance imaging (MRI) for differentiation between various causes of cervical lymphadenopathy was evaluated. In a prospective study, 31 untreated patients (22 males and nine females, aged 5-70 years) with 87 cervical lymph nodes underwent diffusion-weighted MRI before performance of neck dissection (n=14), surgical biopsy (n=9) or core biopsy (n=8). Diffusion-weighted MR images were acquired with a b factor of 0 and 1,000 s/mm2 using single-shot echo-planar sequence. Apparent diffusion coefficient (ADC) maps were reconstructed for all patients. The signal intensity of the lymph nodes was assessed on images obtained at b=0 or 1,000 s/mm2 and from the ADC maps. The ADC value of lymph nodes was also calculated. On the ADC map, malignant nodes showed either low (n=52) or mixed (n=20) signal intensity and benign nodes revealed high (n=13) or low (n=2) signal intensity. The mean ADC value of metastatic (1.09+/-0.11x10(-3) mm2/s) and lymphomatous (0.97+/-0.27x10(-3) mm2/s) lymph nodes was significantly lower than that of benign (1.64+/-0.16x10(-3) mm2/s) cervical lymph nodes (P<0.04). When an ADC value of 1.38x10(-3) mm2/s was used as a threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with an accuracy of 96%, sensitivity of 98%, specificity of 88%, positive predictive value of 98.5% and negative predictive value of 83.7%. The smallest detected lymph node was 0.9 cm. In conclusion, diffusion-weighted MRI with ADC mapping is a new promising technique that can differentiate malignant from benign lymph nodes and delineate the solid viable part of the lymph node for biopsy. This technique provides additional useful physiological and functional information regarding characterization of cervical lymph nodes.

Apparent diffusion coefficient values of necrotic and solid portion of lymph nodes: Differential diagnostic value in cervical lymphadenopathy

“…Several studies have reported the ability of DWI to discriminate malignant from benign lymph nodes in the neck. 10,11 Abdel-Razek et al 1 and Holzapfel et al 7 reported that the ADC value of metastatic nodes is significantly lower than that of benign nodes. However, Sumi et al 3,5 reported significantly higher ADC values in metastatic lymph nodes than in benign lymphadenopathy.…”

“…1 The contrast of DWI depends principally on the degree to which water molecules are free to move within tissues and pass through cell membranes. 8 Diffusion is expressed as an ADC, which reflects the diffusion properties unique to each type of tissue.…”

“…1 Previous studies 1e7 have shown that DWI can be successfully used in the head and neck region, and can be helpful in distinguishing between causes of cervical lymphadenopathy. 1,3,5e7 To the authors' knowledge, in those studies, the apparent diffusion coefficient (ADC) values of lymph nodes without necrosis or the solid portions in the lymph nodes with necrosis were principally analysed, and were used for differential diagnosis.…”

Contemporary management of cancer of the oral cavity

“…Diffusion-weighted magnetic resonance imaging (DWI MRI) may be a helpful complementary tool to distinguish tumoral from non-tumoral tissue, and a sensitivity and specificity for the detection of nodal metastasis of 98 and 88%, respectively, have been reported [60]. …”

Diagnostic performance of diffusion-weighted MRI for detection of pelvic metastatic lymph nodes in patients with cervical cancer: a systematic review and meta-analysis

“…Diffusion-weighted imaging (DWI) is sensitive to the diffusion of water molecules in tissue, which can make subtle abnormality more obvious and can provide better characterization of tissue and their pathological processes at microscopic level. 18 Additionally, the quantitative assessment can be performed by the measurement of the apparent diffusion coefficient (ADC). 19 Of late, DWI has been introduced for the differentiation of benign and malignant lesions in extracranial organs, especially for diagnosis of abdominal and pelvic organs.…”