Magnetic resonance imaging: dynamic contrast enhancement and diffusion-weighted imaging to identify malignant cervical lymph nodes.

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Abstrakt

Tytuł:: Magnetic resonance imaging: dynamic contrast enhancement and diffusion-weighted imaging to identify malignant cervical lymph nodes.
Autorzy:: Cintra MB; MD, PhD, Head and Neck Radiology, Radiology Division, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
Ricz H; MD, PhD, Professor of Head and Neck Surgery, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
Mafee MF; MD, FACR, University of California San Diego (UC San Diego) Health System in La Jolla, San Diego, CA, USA.
Dos Santos AC; MD, PhD, Professor of Neuroradiology, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
Źródło:: Radiologia brasileira [Radiol Bras] 2018 Mar-Apr; Vol. 51 (2), pp. 71-75.
Typ publikacji:: Journal Article
Język:: English
Imprint Name(s):: Original Publication: Rio De Janeiro : Colegio Brasileiro De Radiologia
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Contributed Indexing:: Keywords: Diffusion magnetic resonance imaging; Lymph nodes/diagnostic imaging; Lymphatic metastasis/diagnostic imaging; Magnetic resonance imaging/methods
Local Abstract: [Publisher, Portuguese] Examinar o potencial das imagens de contraste dinâmico (DCE-MRI) e difusão (DW-MRI) em ressonância magnética na detecção de linfonodos cervicais malignos. [Publisher, Portuguese] Foram realizadas DCE-MRI e DW-MRI em 33 linfonodos cervicais. Os valores de realce relativo máximo, realce relativo, tempo de pico, taxa de realce e lavagem, brevidade do realce e área sob a curva foram avaliados pela análise semiquantitativa (DCE-MRI). Os coeficientes de difusão aparente na DW-MRI foram obtidos na área de interesse. Foram excluídas partes císticas ou necróticas dos nódulos. Todos os pacientes foram submetidos a dissecção cervical ou a biópsia. Os resultados de imagem foram correlacionados com os achados patológicos. Nenhum paciente foi submetido a tratamento neoadjuvante antes da dissecção do pescoço. [Publisher, Portuguese] Realce relativo, realce relativo máximo e taxa de realce aumentaram nos nódulos malignos ( p < 0,009, p < 0,05 e p < 0,03, respectivamente). O tempo de pico foi reduzido nos nódulos malignos ( p < 0,02). A análise multivariada identificou tempo de pico (sensibilidade, 73,7%; especificidade, 69,2%) e realce relativo (sensibilidade, 89,2%; especificidade, 69,2%) como variáveis capazes de distinguir os nódulos benignos e malignos. [Publisher, Portuguese] Embora o DCE-MRI possa diferenciar os nódulos benignos e malignos, ainda não há consenso sobre a técnica de análise semiquantitativa, em razão de dificuldade de aplicação clínica. Valores baixos do coeficiente de difusão aparente podem predizer nódulo metastático, mas devem-se considerar também resultados falso-positivos, provavelmente secundários ao processo inflamatório.
Entry Date(s):: Date Created: 20180511 Latest Revision: 20220408
Update Code:: 20240104
PubMed Central ID:: PMC5935398
DOI:: 10.1590/0100-3984.2017.0005
PMID:: 29743732
: Czasopismo naukowe

Pełny tekst

Objective: To examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes.
Materials and Methods: Using DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection.
Results: Relative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes ( p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes ( p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%).
Conclusion: Although DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.

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