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Discrimination of Malignant versus Benign Mediastinal Lymph Nodes Using Diffusion MRI with an IVIM Model

European Radiology volume 28, pages 1301–1309 (2018)Cite this article

Abstract

Objectives

To investigate the value of an intravoxel incoherent motion (IVIM) diffusion model for discriminating malignant versus benign mediastinal lymph nodes (MLN).

Methods

Thirty-five subjects with enlarged MLN were scanned at 1.5 Tesla. Diffusion-weighted imaging was performed with eight b-values. IVIM parameters D, D*, and f, as well as apparent diffusion coefficient (ADC) from a mono-exponential model were obtained. 91 nodes (49 malignant and 42 benign) were analysed with pathologic (n=90) or radiologic (n=1) confirmations. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance.

Results

The mean values of D, ADC, and f for the malignant group were significantly lower than those for the benign group (p<0.001), while D* showed no significant difference (p=0.281). In the ROC analysis, the combination of D and f produced the largest area under the curve (0.953) compared to ADC or other individual IVIM parameters, leading to the best specificity (92.9%) and diagnostic accuracy (90.1%).

Conclusion

This study demonstrates that the combination of IVIM parameters can improve differentiation between malignant and benign MLN as compared to using ADC alone.

Key Points

• Diffusion MRI is useful for non-invasively discriminating malignant versus benign lymph nodes.

• A mono-exponential model is not adequate to characterise diffusion process in lymph nodes.

• IVIM model is advantageous over mono-exponential model for assessing lymph node malignancy.

• Combination of IVIM parameters improves differentiation of malignant versus benign lymph nodes.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the ROC curves

DWI:

Diffusion-weighted imaging

IVIM:

Intravoxel incoherent motion

MLN:

Mediastinal lymph nodes

NSCLC:

Non-small cell lung cancer

ROC:

Receiver operating characteristic

ROI:

Region of interest

T2W:

T2-weighted

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Acknowledgements

The authors would like to thank Jun Zhao, Jin-Feng Chen, Zhen Liang, Jian Fang, and Yu Sun of Peking University Cancer Hospital and Institute for providing support for this study, and Drs. M. Muge Karaman and Jiaxuan Zhang of University of Illinois at Chicago for helpful discussions.

Funding

This study has received funding by Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, China (Program No: 1122-01-1431), and the US National Institute of Health (1S10RR028898).

Author information

Affiliations

  1. Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, No. 52 Fu Cheng Rd, Hai Dian District, Beijing, 100142, China

    Li-Ping Qi, Xiao-Ting Li & Ying-Shi Sun

  2. Center for MR Research, and Department of Radiology, University of Illinois at Chicago, 2242 West Harrison Street, Suite 103, M/C 831, Chicago, IL, 60612, USA

    Li-Ping Qi, Zheng Zhong, Kejia Cai & Xiaohong Joe Zhou

  3. Department of Thoracic Oncosurgery, Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Peking University Cancer Hospital and Institute, Beijing, China

    Wan-Pu Yan & Ke-Neng Chen

  4. Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA

    Zheng Zhong, Kejia Cai & Xiaohong Joe Zhou

  5. Department of Radiology, University of Illinois at Chicago, Chicago, IL, USA

    Kejia Cai & Xiaohong Joe Zhou

  6. Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA

    Xiaohong Joe Zhou

Authors
  1. Li-Ping Qi
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  2. Wan-Pu Yan
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  3. Ke-Neng Chen
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  4. Zheng Zhong
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  5. Xiao-Ting Li
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  7. Ying-Shi Sun
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  8. Xiaohong Joe Zhou
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Corresponding authors

Correspondence to Ying-Shi Sun or Xiaohong Joe Zhou.

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Guarantor

The scientific guarantor of this publication is Liping Qi

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

One of the authors (Xiao-Ting Li) has significant statistical expertise.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Senior authors Ying-Shi Sun and Xiaohong Joe Zhou share the co-corresponding authorship.

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Cite this article

Qi, LP., Yan, WP., Chen, KN. et al. Discrimination of Malignant versus Benign Mediastinal Lymph Nodes Using Diffusion MRI with an IVIM Model. Eur Radiol 28, 1301–1309 (2018). https://doi.org/10.1007/s00330-017-5049-8

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  • DOI: https://doi.org/10.1007/s00330-017-5049-8

Keywords

  • Intravoxel incoherent motion
  • Mediastinal lymph nodes
  • Diffusion-weighted imaging
  • Apparent diffusion coefficient
  • Cancer imaging