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Metastases in normal-sized pelvic lymph nodes: detection with diffusion-weighted MR imaging
Harriet C Thoeny1, Johannes M Froehlich, Maria Triantafyllou
1From the Department of Radiology, Neuroradiology and Nuclear Medicine (H.C.T., J.M.F., M.T., L.J.B., P.V.), Institute of Mathematical Statistics (J.H.), Department of Pathology (A.F.), and Department of Urology (U.E.S.), Inselspital, University of Bern, Freiburgstrasse 10, CH-3010 Bern, Switzerland.
Diffusion-weighted (DW) magnetic resonance (MR) imaging can detect small lymph node metastases in patients with prostate and bladder cancer. This technique offers a noninvasive approach for staging N0 cancer, improving diagnostic accuracy.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Accurate staging of pelvic lymph node involvement is crucial for treatment planning in prostate and bladder cancer.
- Conventional cross-sectional imaging may fail to detect small lymph node metastases.
Purpose of the Study:
- To evaluate the diagnostic performance of diffusion-weighted (DW) magnetic resonance (MR) imaging for detecting pelvic lymph node metastases.
- To assess DW MR imaging in patients with prostate and/or bladder cancer staged as N0 by cross-sectional imaging.
Main Methods:
- Prospective study involving 120 patients with prostate/bladder cancer.
- All patients underwent 3-T MR imaging, including conventional and DW sequences.
- Image analysis by three independent readers; histopathology as the standard of reference.
Main Results:
- 88 metastases found in 33 patients (27.5%); many were small (≤5 mm).
- Per-patient detection sensitivity ranged from 64% to 79%, with specificities from 79% to 85%.
- Per-hemipelvis detection sensitivity ranged from 43% to 64% for the 44 positive cases.
Conclusions:
- DW MR imaging is effective for noninvasively detecting small lymph node metastases in normal-sized nodes.
- This technique can identify metastases missed by conventional cross-sectional imaging in N0 prostate and bladder cancer patients.
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