Differentiating metastatic from nonmetastatic lymph nodes in cervical cancer patients using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging
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.
• 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.
KeywordsCervical cancer Intravoxel incoherent motion Diffusion-weighted imaging Lymph node Magnetic resonance imaging
Intravoxel water diffusion heterogeneity
Apparent diffusion coefficients
Area under the curve
Pure water diffusion
Distributed diffusion coefficient
International Federation of Gynaecology and Obstetrics
Well and moderately differentiated tumours
Poorly differentiated tumours
Intravoxel incoherent motion
Magnetic resonance imaging
Number of excitation
Region of interest
Ratio Short-long diameter ratio
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.
Institutional Review Board approval was obtained.
Written informed consent was obtained from all patients in this study.
• Diagnostic or prognostic study
• Performed at one institution
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