European Radiology

, Volume 27, Issue 12, pp 5272–5279 | Cite as

Differentiating metastatic from nonmetastatic lymph nodes in cervical cancer patients using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging

  • Qingxia Wu
  • Dandan Zheng
  • Ligang Shi
  • Mingbo Liu
  • Meiyun Wang
  • Dapeng Shi
Magnetic Resonance



To determine the diagnostic value of monoexponential, biexponential and stretched exponential models for identifying lymph nodes (LNs) in patients with cervical cancer.

Materials and methods

Fifty female patients with cervical cancer underwent preoperative magnetic resonance imaging. The diffusion parameters of the LNs were calculated by fitting the values to monoexponential, biexponential and stretched exponential models and were compared between the metastatic and non-metastatic LN groups.


A total of 157 LNs with high signal intensity on multi-b-value DWI were detected, 41 of which were pathologically shown to be metastatic. Metastatic LNs presented with higher pure water diffusion (D) values, lower perfusion fraction (f) values, higher diffusion heterogeneity (α) values, higher short diameter (Size-S), long diameter (Size-L) and short long diameter ratio (S/L Ratio) than non-metastatic LNs (P<0.05). The Size-S of LNs exhibited the highest diagnostic value, with an area under the curve of 0.844.


Compared with the size parameters, the diffusion parameters derived from multi-b-value diffusion-weighted imaging cannot reliably discriminate metastatic from non-metastatic LNs in daily clinical routine due to limited sensitivity and specificity.

Key Points

Biexponential and stretched exponential diffusion models can help to characterise LN status.

Metastatic LNs present with higher D and α values, lower f values.

Diffusion parameters were less reliable in discriminating LNs than size parameters.


Cervical cancer Intravoxel incoherent motion Diffusion-weighted imaging Lymph node Magnetic resonance imaging 



Intravoxel water diffusion heterogeneity


Apparent diffusion coefficients


Area under the curve


Concurrent chemoradiotherapy


Pure water diffusion




Distributed diffusion coefficient


Diffusion-weighted imaging


Perfusion fraction


International Federation of Gynaecology and Obstetrics


Well and moderately differentiated tumours


Poorly differentiated tumours


Intravoxel incoherent motion


Lymph node


Magnetic resonance imaging


Number of excitation


Region of interest


Ratio Short-long diameter ratio


Long diameter


Short diameter


Repetition time/echo time


Compliance with ethical standards


The scientific guarantor of this publication is Dapeng Shi.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

The author Dandan Zheng is an employee of GE Healthcare.


This study has received funding by the Chinese National Natural Science Foundation (Grant number 81271534).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

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


• Prospective

• Diagnostic or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Qingxia Wu
    • 1
  • Dandan Zheng
    • 2
  • Ligang Shi
    • 3
  • Mingbo Liu
    • 4
  • Meiyun Wang
    • 1
  • Dapeng Shi
    • 1
  1. 1.Radiological Department of Henan Provincial People’s HospitalZhengzhouChina
  2. 2.GE Healthcare, MR Research ChinaBeijingChina
  3. 3.Pathological Department of Henan Provincial People’s HospitalZhengzhouChina
  4. 4.Radiotherapeutical Department of Henan Provincial People’s HospitalZhengzhouChina

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