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Apparent diffusion coefficient for discriminating metastatic from non-metastatic lymph nodes in primary rectal cancer
Een Young Cho1, Seung Ho Kim, Jung-Hee Yoon
1Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Haeundae-ro 875, Haeundae-gu, Busan 612 030, Republic of Korea.
Objective:
To investigate whether the apparent diffusion coefficient (ADC) could be used to discriminate metastatic from non-metastatic lymph nodes (LNs) in patients with primary rectal cancer.
Methods:
This study investigated 34 patients (male: 12, female: 22, mean: 62.7, range: 37-82) who underwent 1.5-T MRI with diffusion-weighted imaging (DWI) and subsequent surgical resection. A blinded radiologist measured the ADC value in each regional LN after referring to the T2-weighted images and DWI. The t-test was used to compare the mean ADC values of the metastatic and non-metastatic LNs. A ROC analysis was performed to calculate the diagnostic performance and obtain the optimal cut-off. The histopathological results were used as the reference standard.
Results:
114 LNs (46 metastatic and 68 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly lower than that of the non-metastatic LNs (0.9 ± 0.15 × 10(-3) mm(2)/s; 1.1 ± 0.22 × 10(-3) mm(2)/s, P<0.0001). The area under the ROC curve was 0.734 (95% confidence interval, 0.644-0.812). When an ADC value of 1.0 × 10(-3) mm(2)/s was used as the cut-off, a maximum accuracy of 72% was calculated (sensitivity, 78%; specificity, 67%).
Conclusions:
Although ADC could be used to discriminate metastatic from non-metastatic LNs, the diagnostic accuracy is approximately 70%.
