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Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma

  • Magnetic Resonance
  • Published:
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Abstract

Objectives

To evaluate the diagnostic potential of intravoxel incoherent motion (IVIM) DWI for differentiating metastatic and non-metastatic lymph node stations (LNS) in pancreatic ductal adenocarcinoma (PDAC).

Methods

59 LNS histologically diagnosed following surgical resection from 15 patients were included. IVIM DWI with 12 b values was added to the standard MRI protocol. Evaluation of parameters was performed pre-operatively and included the apparent diffusion coefficient (ADC), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*) and perfusion fraction (f). Diagnostic performance of ADC, D, D* and f for differentiating between metastatic and non-metastatic LNS was evaluated using ROC analysis.

Results

Metastatic LNS had significantly lower D, D*, f and ADC values than the non-metastatic LNS (p< 0.01). The best diagnostic performance was found in D, with an area under the ROC curve of 0.979, while the area under the ROC curve values of D*, f and ADC were 0.867, 0.855 and 0.940, respectively. The optimal cut-off values for distinguishing metastatic and non-metastatic lymph nodes were D = 1.180 × 10−3 mm2/s; D* = 14.750 × 10−3 mm2/s, f = 20.65 %, and ADC = 1.390 × 10−3 mm2/s.

Conclusion

IVIM DWI is useful for differentiating between metastatic and non-metastatic LNS in PDAC.

Key Points

• IVIM DWI is feasible for diagnosing LN metastasis in PDAC.

• Metastatic LNS has lower D, D*, f, ADC values than non-metastatic LNS.

• D-value from IVIM model has best diagnostic performance, followed by ADC value.

• D* has the lowest AUC value.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the receiver operating characteristic curve

D:

True diffusion coefficient

D*:

Pseudo-diffusion coefficient

DWI:

Diffusion-weighted imaging

f:

Perfusion fraction

ICC:

Intraclass correlation coefficient

IVIM:

Intravoxel incoherent motion

LNS:

Lymph node stations

PD:

Pancreaticoduodenectomy

PDAC:

Pancreatic ductal adenocarcinoma

PTAC:

Pancreaticobiliary-type ampullary carcinoma

ROI:

Region of interest

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Acknowledgements

We would like to thank the native English-speaking scientists of Elixigen Company (Huntington Beach, California) for editing our manuscript.

Funding

The authors state that this work has not received any funding.

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Author notes

  1. Dailin Rong and Yize Mao contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Oncology in Southern China, Guangzhou, 510060, China

    Dailin Rong, Yize Mao, Wanming Hu, Jun Wang, Haoqiang He, Shengping Li & Rong Zhang

  2. Department of Radiology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China

    Dailin Rong, Haoqiang He & Rong Zhang

  3. Department of Hepato-Biliary-Pancreatic Oncology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China

    Yize Mao, Jun Wang & Shengping Li

  4. Department of Pathology, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China

    Wanming Hu

  5. Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, Guangdong Province, People’s Republic of China

    Shuhang Xu

  6. Department of Ultrasound, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, China

    Jun Wang

Authors
  1. Dailin Rong
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Corresponding authors

Correspondence to Shengping Li or Rong Zhang.

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Rong Zhang, Sun Yat-Sen University Cancer Center.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

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Rong, D., Mao, Y., Hu, W. et al. Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma. Eur Radiol 28, 2781–2789 (2018). https://doi.org/10.1007/s00330-017-5259-0

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  • DOI: https://doi.org/10.1007/s00330-017-5259-0

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