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European Radiology

, Volume 28, Issue 7, pp 2781–2789 | Cite as

Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma

  • Dailin Rong
  • Yize Mao
  • Wanming Hu
  • Shuhang Xu
  • Jun Wang
  • Haoqiang He
  • Shengping LiEmail author
  • Rong ZhangEmail author
Magnetic Resonance

Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusion

IVIM DWI is useful for differentiating between metastatic and non-metastatic LNS in PDAC.

Key Points

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.

Keywords

Intravoxel incoherent motion Diffusion-weighted imaging Magnetic resonance imaging Lymph node station Pancreatic ductal carcinoma 

Abbreviations

ADC

Apparent diffusion coefficient

AUC

Area under the receiver operating characteristic curve

D

True diffusion coefficient

D*

Pseudo-diffusion coefficient

DWI

Diffusion-weighted imaging

f

Perfusion fraction

ICC

Intraclass correlation coefficient

IVIM

Intravoxel incoherent motion

LNS

Lymph node stations

PD

Pancreaticoduodenectomy

PDAC

Pancreatic ductal adenocarcinoma

PTAC

Pancreaticobiliary-type ampullary carcinoma

ROI

Region of interest

Notes

Acknowledgements

We would like to thank the native English-speaking scientists of Elixigen Company (Huntington Beach, California) for editing our manuscript.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

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.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• observational

• performed at one institution

Supplementary material

330_2017_5259_MOESM1_ESM.docx (6.5 mb)
ESM 1 (DOCX 6661 kb)

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.State Key Laboratory of Oncology in Southern ChinaGuangzhouChina
  2. 2.Department of RadiologySun Yat-sen University Cancer CenterGuangzhouChina
  3. 3.Department of Hepato-Biliary-Pancreatic OncologySun Yat-Sen University Cancer CenterGuangzhouChina
  4. 4.Department of PathologySun Yat-sen University Cancer CenterGuangzhouChina
  5. 5.Department of UltrasoundThe Third Affiliated Hospital of Sun Yat-sen UniversityGuangzhouPeople’s Republic of China
  6. 6.Department of UltrasoundSun Yat-sen University Cancer CenterGuangzhouChina

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