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Value of apparent diffusion coefficient for differentiating peripancreatic tuberculous lymphadenopathy from metastatic lymphadenopathy

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Abstract

Purpose

To evaluate effectiveness of the apparent diffusion coefficient (ADC) values of the peripancreatic lymphadenopathy to differentiate tuberculous lymphadenopathy from metastatic lymphadenopathy.

Materials and methods

Twenty-nine patients with 65 peripancreatic necrotic tuberculous lymphadenopathy and 31 patients with 47 peripancreatic necrotic metastatic lymphadenopathy from pancreatic ductal adenocarcinoma, who underwent magnetic resonance imaging (MRI), were included in this study. MRI features in the T1-weighted image (WI), T2WI, and diffusion-weighted image were analyzed. The ADC values of necrotic and non-necrotic portions of the lymph nodes were measured and compared using t test. Receiver operating characteristic analysis was performed to obtain the optimal ADC threshold value and diagnostic accuracy for differentiating tuberculous lymphadenopathy from metastatic lymphadenopathy.

Results

On T2WI, the signal intensity of necrotic portions was variable in tuberculous lymphadenopathy, but was mostly high in metastatic lymphadenopathy. The mean ADCs of necrotic portions of tuberculous lymphadenopathy were significantly lower than those of metastatic lymphadenopathy ([0.919 ± 0.272] × 10−3 mm2/s vs. [1.553 ± 0.406] × 10−3 mm2/s, p < 0.001). Receiver operating characteristic analysis for differentiating tuberculous from metastatic lymphadenopathy demonstrated an area under the curve for the ADC values of necrotic portions of 0.929 (95% CI, 0.865–0.969) with an ADC threshold of 1.022. The sensitivity and specificity for the differentiation of tuberculous from metastatic lymphadenopathy were 80.0% and 97.8%, respectively.

Conclusion

The ADC values of necrotic portions of peripancreatic lymphadenopathy may be useful for differentiating tuberculous from metastatic lymphadenopathy.

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Abbreviations

ADC:

Apparent diffusion coefficient

AFB:

Acid-fast bacilli

AUC:

Area under the curve

CT:

Computed tomography

DWI:

Diffusion-weighted imaging

EUS:

Endoscopic ultrasonography

FNA:

Fine needle aspiration

MRI:

Magnetic resonance imaging

PCR:

Polymerase chain reaction

PDAC:

Pancreatic ductal adenocarcinoma

PET:

Positron emission tomography

ROC:

Receiver operating characteristic

ROI:

Region of interest

SI:

Signal intensity

T1WI:

T1-weighted imaging

T2WI:

T2-weighted imaging

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Authors and Affiliations

  1. Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-Ro 43-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea

    Jimi Huh, Jae Ho Byun, Jin Hee Kim, Seung Soo Lee, Hyoung Jung Kim & Moon-Gyu Lee

  2. Department of Radiology, Ajou University School of Medicine & Graduate School of Medicine, Ajou University Medical Center, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea

    Jimi Huh & Jae Keun Kim

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  1. Jimi Huh
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Correspondence to Jae Ho Byun.

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Our institutional review board approved this retrospective observational study and waived the requirement for informed consent.

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Huh, J., Byun, J.H., Kim, J.H. et al. Value of apparent diffusion coefficient for differentiating peripancreatic tuberculous lymphadenopathy from metastatic lymphadenopathy. Abdom Radiol 45, 3163–3171 (2020). https://doi.org/10.1007/s00261-020-02501-x

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