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[Diffusion-weighted MR imaging for postoperative nodal recurrence of esophageal squamous cell cancer in comparison

Kiyohiko Shuto1, Hiroshige Saito, Gaku Ohira

  • 1Department of Frontier Surgery, Graduate School of Medicine, Chiba University.

Gan to Kagaku Ryoho. Cancer & Chemotherapy
|December 29, 2009
PubMed

Insights

Diffusion-weighted whole-body imaging with background suppression (DWIBS) effectively detects esophageal cancer recurrence in lymph nodes, showing performance comparable to FDG-PET scans. This noninvasive technique offers a reliable alternative for diagnosing nodal recurrence.

Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • Esophageal cancer recurrence, particularly in lymph nodes, poses a significant clinical challenge.
  • Accurate detection of nodal recurrence is crucial for effective patient management and treatment planning.
  • Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a standard imaging modality for recurrence detection.

Purpose of the Study:

  • To evaluate the diagnostic power of Diffusion-Weighted Whole-Body Imaging with Background Suppression (DWIBS) for detecting postoperative lymph node recurrence of esophageal cancer.
  • To compare the efficacy of DWIBS with Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) in identifying recurrent esophageal cancer.
  • To assess the diagnostic accuracy of apparent diffusion coefficient (ADC) values in differentiating recurrent lymph nodes from normal esophageal tissue.

Main Methods:

  • A study involving 47 patients with suspected lymph node recurrence of esophageal cancer, identified by multi-detector computed tomography (MDCT).
  • Comparison of diagnostic performance metrics (sensitivity, positive predictive value, overall accuracy) between DWIBS and FDG-PET.
  • Measurement and analysis of apparent diffusion coefficient (ADC) values for recurrent nodes, primary cancer, and normal esophagus.

Main Results:

  • DWIBS demonstrated high sensitivity (95%) and positive predictive value (83%), comparable to FDG-PET (97% sensitivity, 90% PPV).
  • Overall accuracy rates for DWIBS (81%) and FDG-PET (87%) were not significantly different.
  • Recurrent lymph nodes exhibited significantly lower ADC values (1.124 x10(-3) mm2/s) compared to normal esophagus (2.079 x10(-3) mm2/s) (p<0.0001).
  • A cut-off ADC value of 1.5 x10(-3) mm2/s achieved 100% accuracy in distinguishing recurrent lesions from normal esophageal tissue.

Conclusions:

  • Noninvasive DWIBS is a valuable imaging modality for discriminating nodal recurrence in esophageal cancer patients.
  • DWIBS exhibits diagnostic performance comparable to FDG-PET for detecting lymph node recurrence.
  • ADC measurements using DWIBS provide a reliable method for differentiating recurrent esophageal cancer from normal tissue.

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