Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma
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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).
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.
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.
IVIM DWI is useful for differentiating between metastatic and non-metastatic LNS in PDAC.
• 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.
KeywordsIntravoxel incoherent motion Diffusion-weighted imaging Magnetic resonance imaging Lymph node station Pancreatic ductal carcinoma
Apparent diffusion coefficient
Area under the receiver operating characteristic curve
True diffusion coefficient
Intraclass correlation coefficient
Intravoxel incoherent motion
Lymph node stations
Pancreatic ductal adenocarcinoma
Pancreaticobiliary-type ampullary carcinoma
Region of interest
We would like to thank the native English-speaking scientists of Elixigen Company (Huntington Beach, California) for editing our manuscript.
The authors state that this work has not received any funding.
Compliance with ethical standards
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.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
• performed at one institution
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