Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 7/2018

01-07-2018 | Magnetic Resonance

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

Authors: Dailin Rong, Yize Mao, Wanming Hu, Shuhang Xu, Jun Wang, Haoqiang He, Shengping Li, Rong Zhang

Published in: European Radiology | Issue 7/2018

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Becker AE, Hernandez YG, Frucht H, Lucas AL (2014) Pancreatic ductal adenocarcinoma: risk factors, screening, and early detection. World J Gastroenterol 20:11182–11198CrossRefPubMedPubMedCentral
2.
Krska Z, Svab J, Hoskovec D, Ulrych J (2015) Pancreatic Cancer Diagnostics and Treatment--Current State. Prague Med Rep 116:253–267CrossRefPubMed
3.
Lim JE, Chien MW, Earle CC (2003) Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg 240:74–85CrossRef
4.
Schwarz RE, Smith DD (2006) Extent of lymph node retrieval and pancreatic cancer survival: information from a large US population database. Ann Surg Oncol 13:1189–1200CrossRefPubMed
5.
Gilabert M, Boher JM, Raoul JL et al (2017) Comparison of preoperative imaging and pathological findings for pancreatic head adenocarcinoma: A retrospective analysis by the Association Francaise de Chirurgie. Medicine (Baltimore) 96:e7214CrossRef
6.
Kauhanen SP, Komar G, Seppanen MP et al (2009) A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer. Ann Surg 250:957–963CrossRefPubMed
7.
Tseng DS, van Santvoort HC, Fegrachi S et al (2014) Diagnostic accuracy of CT in assessing extra-regional lymphadenopathy in pancreatic and peri-ampullary cancer: a systematic review and meta-analysis. Surg Oncol 23:229–235CrossRefPubMed
8.
Asagi A, Ohta K, Nasu J et al (2013) Utility of contrast-enhanced FDG-PET/CT in the clinical management of pancreatic cancer: impact on diagnosis, staging, evaluation of treatment response, and detection of recurrence. Pancreas 42:11–19CrossRefPubMed
9.
Fong ZV, Tan WP, Lavu H et al (2013) Preoperative imaging for resectable periampullary cancer: clinicopathologic implications of reported radiographic findings. J Gastrointest Surg 17:1098–1106CrossRefPubMed
10.
Imai H, Doi R, Kanazawa H et al (2010) Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol 15:294–300CrossRefPubMed
11.
Soriano A, Castells A, Ayuso C et al (2004) Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99:492–501CrossRefPubMed
12.
Le BD, Breton E, Lallemand D, Grenier P, Cabanis E, Lavaljeantet M (1986) MR imaging of intravoxel incoherent motions: application to diffusion and perfusion in neurologic disorders. Radiology 161:401CrossRef
13.
Yu XP, Wen L, Hou J et al (2016) Discrimination between Metastatic and Nonmetastatic Mesorectal Lymph Nodes in Rectal Cancer Using Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging. Acad Radiol 23:479–485CrossRefPubMed
14.
Qiu L, Liu XL, Liu SR et al (2016) Role of quantitative intravoxel incoherent motion parameters in the preoperative diagnosis of nodal metastasis in patients with rectal carcinoma. J Magn Reson Imaging 44:1031–1039CrossRefPubMed
15.
Ye X, Chen S, Tian Y et al (2017) A preliminary exploration of the intravoxel incoherent motion applied in the preoperative evaluation of mediastinal lymph node metastasis of lung cancer. J Thorac Dis 9:1073–1080CrossRefPubMedPubMedCentral
16.
Liang L, Luo X, Lian Z et al (2017) Lymph node metastasis in head and neck squamous carcinoma: Efficacy of intravoxel incoherent motion magnetic resonance imaging for the differential diagnosis. Eur J Radiol 90:159–165CrossRefPubMed
17.
Bosman FT, World Health Organization., International Agency for Research on Cancer (2010) WHO classification of tumours of the digestive system, 4th edn. International Agency for Research on Cancer, Lyon
18.
Westgaard A, Tafjord S, Farstad IN et al (2008) Pancreatobiliary versus intestinal histologic type of differentiation is an independent prognostic factor in resected periampullary adenocarcinoma. BMC Cancer 8:1–11CrossRef
19.
Chang DK, Jamieson NB, Johns AL et al (2013) Histomolecular phenotypes and outcome in adenocarcinoma of the ampulla of vater. J Clin Oncol 31:1348–1356CrossRefPubMed
20.
Kim JH, Kim MJ, Chung JJ, Lee WJ, Yoo HS, Lee JT (2002) Differential diagnosis of periampullary carcinomas at MR imaging. Radiographics 22:1335–135
21.
Dixon WT (1988) Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging: a modest proposal with tremendous potential. Radiology 168:566–567CrossRefPubMed
22.
Marquardt DW (1963) An Algorithm for Least-Squares Estimation of Nonlinear Parameters. J Soc Ind Appl Math 11:431–441CrossRef
23.
Sobin LH, Gospodarowicz MK, Wittekind C, International Union against Cancer (2010) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, Chichester, West Sussex, Hoboken
24.
Capurso G, Signoretti M, Valente R et al (2015) Methods and outcomes of screening for pancreatic adenocarcinoma in high-risk individuals. World J Gastrointest Endosc 7:833–842CrossRefPubMedPubMedCentral
25.
Lemke A, Laun FB, Klauss M et al (2009) Differentiation of pancreas carcinoma from healthy pancreatic tissue using multiple b-values: comparison of apparent diffusion coefficient and intravoxel incoherent motion derived parameters. Invest Radiol 44:769CrossRefPubMed
26.
Yi WM, Chen ZE, Paul Nikolaidis MD et al (2011) Diffusion-weighted magnetic resonance imaging of pancreatic adenocarcinomas: Association with histopathology and tumor grade. J Magn Reson Imaging 33:136–142CrossRef
27.
Fattahi R, Balci NC, Perman WH et al (2010) Pancreatic diffusion-weighted imaging (DWI): comparison between mass-forming focal pancreatitis (FP), pancreatic cancer (PC), and normal pancreas. J Magn Reson Imaging 29:350–356CrossRef
28.
Klauss M, Maier-Hein K, Tjaden C, Hackert T, Grenacher L, Stieltjes B (2016) IVIM DW-MRI of autoimmune pancreatitis: therapy monitoring and differentiation from pancreatic cancer. Eur Radiol 26:2099–2106CrossRefPubMed
29.
Lu Y, Jansen JF, Stambuk HE et al (1900) Comparing primary tumors and metastatic nodes in head and neck cancer using intravoxel incoherent motion imaging: a preliminary experience. J Comput Assist Tomogr 37:346–352CrossRef
30.
Kwee TC, Takahara T, Niwa T et al (2009) Influence of cardiac motion on diffusion-weighted magnetic resonance imaging of the liver. Magn Reson Mater Phys Biol Med 22:319–325CrossRef
31.
Cohen AD, Schieke MC, Hohenwalter MD, Schmainda KM (2015) The effect of low b-values on the intravoxel incoherent motion derived pseudodiffusion parameter in liver. Magn Reson Med 73:306–311CrossRefPubMed
32.
Shinmoto H, Tamura C, Soga S et al (2012) An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer. AJR Am J Roentgenol 199:W496CrossRefPubMed
33.
Fukukura Y, Shindo T, Hakamada H et al (2016) Diffusion-weighted MR imaging of the pancreas: optimizing b-value for visualization of pancreatic adenocarcinoma. Eur Radiol 26:3419–3427CrossRefPubMed
34.
Luciani A, Vignaud A, Cavet M et al (2008) Liver cirrhosis: intravoxel incoherent motion MR imaging--pilot study. Radiology 249:891–899CrossRefPubMed
35.
Lemke A, Laun FB, Klauss M et al (2009) Differentiation of pancreas carcinoma from healthy pancreatic tissue using multiple b-values: comparison of apparent diffusion coefficient and intravoxel incoherent motion derived parameters. Investig Radiol 44:769–775CrossRef
36.
Yamada I, Aung W, Himeno Y, Nakagawa T, Shibuya H (1999) Diffusion coefficients in abdominal organs and hepatic lesions: evaluation with intravoxel incoherent motion echo-planar MR imaging. Radiology 210:617–623CrossRefPubMed
37.
Lemke A, Stieltjes B, Schad LR, Laun FB (2011) Toward an optimal distribution of b values for intravoxel incoherent motion imaging. Magn Reson Imaging 29:766–776CrossRefPubMed
38.
Lee Y, Lee SS, Kim N et al (2015) Intravoxel incoherent motion diffusion-weighted MR imaging of the liver: effect of triggering methods on regional variability and measurement repeatability of quantitative parameters. Radiology 274:405–415CrossRefPubMed
39.
Barbieri S, Donati OF, Froehlich JM, Thoeny HC (2016) Impact of the calculation algorithm on biexponential fitting of diffusion-weighted MRI in upper abdominal organs. Magn Reson Med 75:2175–2184CrossRefPubMed
Metadata
Title
Intravoxel incoherent motion magnetic resonance imaging for differentiating metastatic and non-metastatic lymph nodes in pancreatic ductal adenocarcinoma
Authors
Dailin Rong
Yize Mao
Wanming Hu
Shuhang Xu
Jun Wang
Haoqiang He
Shengping Li
Rong Zhang
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 7/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5259-0

Other articles of this Issue 7/2018

European Radiology 7/2018 Go to the issue

Radiological Education

Contrast-enhanced cadaver-specific computed tomography in gross anatomy teaching

Cardiac

High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

Urogenital

Structured reporting of pelvic MRI leads to better treatment planning of uterine leiomyomas

Interventional

Ablation of colorectal liver metastasis: Interaction of ablation margins and RAS mutation profiling on local tumour progression-free survival

Hepatobiliary-Pancreas

Glypican-1 circulating exosomes: a promising clue to individualize surveillance of pancreatic cysts?

Correction

Correction to: Baseline and annual repeat rounds of screening: implications for optimal regimens of screening