Non-invasive MR assessment of the microstructure and microcirculation in regional lymph nodes for rectal cancer: a study of intravoxel incoherent motion imaging
Tóm tắt
The aim of this study is to evaluate the microstructure and microcirculation of regional lymph nodes (LNs) in rectal cancer by using non-invasive intravoxel incoherent motion MRI (IVIM-MRI), and to distinguish metastatic from non-metastatic LNs by quantitative parameters. All recruited patients underwent IVIM-MRI (b = 0, 5, 10, 20, 30, 40, 60, 80, 100, 150, 200, 400, 600, 1000, 1500 and 2000 s/mm2) on a 3.0 T MRI system. One hundred sixty-eight regional LNs with a short-axis diameter equal to or greater than 5 mm from 116 patients were evaluated by two radiologists independently, including 78 malignant LNs and 90 benign LNs. The following parameters were assessed: the short-axis diameter (S), long-axis diameter (L), short- to long-axis diameter ratio (S/L), pure diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion factor (f). Intraclass correlation coefficients (ICCs) were calculated to assess the interobserver agreement between two readers. Receiver operating characteristic curves were applied for analyzing statistically significant parameters. Interobserver agreement of IVIM-MRI parameters between two readers was excellent (ICCs> 0.75). The metastatic group exhibited higher S, L and D (P < 0.001), but lower f (P < 0.001) than the non-metastatic group. The area under the curve (95% CI, sensitivity, specificity) of the multi-parameter combined equation for D, f and S was 0.811 (0.744~0.868, 62.82%, 87.78%). The diagnostic performance of the multi-parameter model was better than that of an individual parameter (P < 0.05). IVIM-MRI parameters provided information about the microstructure and microcirculation of regional LNs in rectal cancer, also improved diagnostic performance in identifying metastatic LNs.
Tài liệu tham khảo
Benson AB, Venook AP, Al-Hawary MM, et al. Rectal Cancer, version 2.2018, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2018;16:874–901.
Kim JH, Beets GL, Kim M-J, Kessels AGH, Beets-Tan RGH. High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size? Eur J Radiol. 2004;52:78–83.
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, Williams GT. Morphologic predictors of lymph node status in rectal Cancer with use of high-spatial-resolution MR imaging with Histopathologic comparison. Radiology. 2003;227:371–7.
Zhang H, Zhang C, Zheng Z, et al. Chemical shift effect predicting lymph node status in rectal cancer using high-resolution MR imaging with node-for-node matched histopathological validation. Eur Radiol. 2017;27:1–11.
Citil S, Dogan S, Atilgan HI, et al. Comparison of dynamic contrast-enhanced MRI and PET/CT in the evaluation of laryngeal Cancer after inadequate CT results. Pol J Radiol. 2015;80:428–32.
Huang W, Tudorica LA, Li X, et al. Discrimination of benign and malignant breast lesions by using shutter-speed dynamic contrast-enhanced MR imaging. Radiology. 2011;261:394–403.
Tofts PS, Brix G, Buckley DL, et al. Estimating kinetic parameters from dynamic contrast-enhanced T (1)-weighted MRI of a diffusable tracer: standardized quantities and symbols. J Magn Reson Imaging. 1999;10:223–32.
Yu XP, Wen L, Hou J, Wang H, Lu Q. Discrimination of metastatic from non-metastatic mesorectal lymph nodes in rectal cancer using quantitative dynamic contrast-enhanced magnetic resonance imaging. J Huazhong Univ Sci Technol Med Sci. 2016;36:594–600.
Dzik-Jurasz A, Domenig C, George M, et al. Diffusion MRI for prediction of response of rectal cancer to chemoradiation. Lancet. 2002;360:307–8.
Cho EY, Kim SH, Yoon JH, et al. Apparent diffusion coefficient for discriminating metastatic from non-metastatic lymph nodes in primary rectal cancer. Eur J Radiol. 2013;82:e662–8.
Heijnen LA, Lambregts DMJ, Mondal D, et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes. Eur Radiol. 2013;23:3354–60.
Le Bihan D. Apparent diffusion coefficient and beyond: what diffusion MR imaging can tell us about tissue structure. Radiology. 2013;268:318–22.
Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology. 1988;168:497–505.
Yu XP, Wen L, Hou J, et al. Discrimination between metastatic and nonmetastatic Mesorectal lymph nodes in rectal Cancer using Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging. Acad Radiol. 2016;23:1–7.
Qiu L, Liu XL, Liu SR, et al. Role of quantitative intravoxel incoherent motion parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma. J Magn Reson Imaging. 2016;44:1031–9.
Suo S, Lin N, Wang H, et al. Intravoxel incoherent motion diffusion-weighted MR imaging of breast cancer at 3.0 tesla: Comparison of different curve-fitting methods. J Magn Reson Imaging. 2014;42:362–70.
Nougaret S, Vargas HA, Lakhman Y, et al. Intravoxel incoherent motion–derived histogram metrics for assessment of response after combined chemotherapy and radiation therapy in rectal Cancer: initial experience and comparison between single-section and volumetric analyses. Radiology. 2016;280:446–54.
Cui C, Cai H, Liu L, Li L, Tian H, Li L. Quantitative analysis and prediction of regional lymph node status in rectal cancer based on computed tomography imaging. Eur Radiol. 2011;21:2318–25.
Edge SB, Compton CC. The American joint committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010;17:1471–4.
Cicchetti DV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess. 1994;6:284–90.
Langman G, Patel A, Bowley DM. Size and distribution of lymph nodes in rectal cancer resection specimens. Dis Colon Rectum. 2015;58:406–14.
Willard-Mack CL. Normal structure, function, and histology of lymph nodes. Toxicol Pathol. 2006;34:409–24.
Semeraro D, Davies JD. The arterial blood supply of human inguinal and mesenteric lymph nodes. J Anat. 1986;144:221–33.
Naresh KN, Nerurkar AY, Borges AM. Angiogenesis is redundant for tumor growth in lymph node metastases. Histopathology. 2001;38:466–70.
Holash J, Wiegand SJ, Yancopoulos GD. New model of tumor angiogenesis: dynamic balance between vessel regression and growth mediated by angiopoietins and VEGF. Oncogene. 1999;18:5356–62.
Wu Q, Zheng D, Shi L, Liu M, Wang M, Shi D. Differentiating metastatic from nonmetastatic lymph nodes in cervical cancer patients using monoexponential, biexponential, and stretched exponential diffusion-weighted MR imaging. Eur Radiol. 2017;27:1–8.
Wang LL, Lin J, Liu K, et al. Intravoxel incoherent motion diffusion-weighted MR imaging in differentiation of lung cancer from obstructive lung consolidation: comparison and correlation with pharmacokinetic analysis from dynamic contrast-enhanced MR imaging. Eur Radiol. 2014;24:1914–22.
Zhu Y, Li X, Wang F, et al. Intravoxel incoherent motion diffusion-weighted magnetic resonance imaging in characterization of axillary lymph nodes: preliminary animal experience. Magn Reson Imaging. 2018;52:46–52.
Liang L, Luo X, Lian Z, et al. Lymph node metastasis in head and neck squamous carcinoma: efficacy of intravoxel incoherent motion magnetic resonance imaging for the differential diagnosis. Eur J Radiol. 2017;90:1–29.
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. 2017;28:1–9.
King AD, Vlantis AC, Tsang RKY, et al. Magnetic resonance imaging for the detection of nasopharyngeal carcinoma. AJNR Am J Neuroradiol. 2006;27:1288–91.
Joo I, Lee JM, Yoon JH, Jang JJ, Han JK, Choi BI. Nonalcoholic fatty liver disease: Intravoxel incoherent motion diffusion-weighted MR imaging—an experimental study in a rabbit model. Radiology. 2014;270:131–40.
Dyvorne HA, Galea N, Nevers T, et al. Diffusion-weighted imaging of the liver with multiple bValues: effect of diffusion gradient polarity and breathing acquisition on image quality and Intravoxel incoherent motion parameters—a pilot study. Radiology. 2013;266:920–9.
Guiu B, Petit JM, Capitan V, et al. Intravoxel Incoherent Motion Diffusion-weighted Imaging in Nonalcoholic Fatty Liver Disease: A 3.0-T MR Study. Radiology. 2012;265:96–103.
Kakite S, Dyvorne H, Besa C, et al. Hepatocellular carcinoma: short-term reproducibility of apparent diffusion coefficient and intravoxel incoherent motion parameters at 3.0T. J Magn Reson Imaging 2014;41:149–156.
Ye X, Chen S, Tian Y, et al. A preliminary exploration of the intravoxel incoherent motion applied in the preoperative evaluation of mediastinal lymph node metastasis of lung cancer. J Thorac Dis. 2017;9:1073–80.