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For: Cheng J, Wang Y, Deng J, McCarthy RJ, Wang G, Wang H, Ye Y. Discrimination of metastatic lymph nodes in patients with gastric carcinoma using diffusion-weighted imaging. J Magn Reson Imaging 2012;37:1436-44. [PMID: 23172760 DOI: 10.1002/jmri.23925] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 10/01/2012] [Indexed: 12/13/2022] Open

For:	Cheng J, Wang Y, Deng J, McCarthy RJ, Wang G, Wang H, Ye Y. Discrimination of metastatic lymph nodes in patients with gastric carcinoma using diffusion-weighted imaging. J Magn Reson Imaging 2012;37:1436-44. [PMID: 23172760 DOI: 10.1002/jmri.23925] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 10/01/2012] [Indexed: 12/13/2022] Open

Number

Cited by Other Article(s)

Noto B, Eveslage M, Auf der Springe K, Exler A, Faldum A, Heindel W, Milachowski S, Roll W, Schäfers M, Stegger L, Bauer J. Robustness of apparent diffusion coefficient-based lymph node classification for diagnosis of prostate cancer metastasis. Eur Radiol 2024;34:4504-4515. [PMID: 38099965 PMCID: PMC11213742 DOI: 10.1007/s00330-023-10406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 10/01/2023] [Indexed: 06/29/2024]

Abstract

OBJECTIVES

The aim of this proof-of-principle study combining data analysis and computer simulation was to evaluate the robustness of apparent diffusion coefficient (ADC) values for lymph node classification in prostate cancer under conditions comparable to clinical practice.

MATERIALS AND METHODS

To assess differences in ADC and inter-rater variability, ADC values of 359 lymph nodes in 101 patients undergoing simultaneous prostate-specific membrane antigen (PSMA)-PET/MRI were retrospectively measured by two blinded readers and compared in a node-by-node analysis with respect to lymph node status. In addition, a phantom and 13 patients with 86 lymph nodes were prospectively measured on two different MRI scanners to analyze inter-scanner agreement. To estimate the diagnostic quality of the ADC in real-world application, a computer simulation was used to emulate the blurring caused by scanner and reader variability. To account for intra-individual correlation, the statistical analyses and simulations were based on linear mixed models.

RESULTS

The mean ADC of lymph nodes showing PSMA signals in PET was markedly lower (0.77 × 10-3 mm2/s) compared to inconspicuous nodes (1.46 × 10-3 mm2/s, p < 0.001). High inter-reader agreement was observed for ADC measurements (ICC 0.93, 95%CI [0.92, 0.95]). Good inter-scanner agreement was observed in the phantom study and confirmed in vivo (ICC 0.89, 95%CI [0.84, 0.93]). With a median AUC of 0.95 (95%CI [0.92, 0.97]), the simulation study confirmed the diagnostic potential of ADC for lymph node classification in prostate cancer.

CONCLUSION

Our model-based simulation approach implicates a high potential of ADC for lymph node classification in prostate cancer, even when inter-rater and inter-scanner variability are considered.

CLINICAL RELEVANCE STATEMENT

The ADC value shows a high diagnostic potential for lymph node classification in prostate cancer. The robustness to scanner and reader variability implicates that this easy to measure and widely available method could be readily integrated into clinical routine.

KEY POINTS

• The diagnostic value of the apparent diffusion coefficient (ADC) for lymph node classification in prostate cancer is unclear in the light of inter-rater and inter-scanner variability. • Metastatic and inconspicuous lymph nodes differ significantly in ADC, resulting in a high diagnostic potential that is robust to inter-scanner and inter-rater variability. • ADC has a high potential for lymph node classification in prostate cancer that is maintained under conditions comparable to clinical practice.

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Zhu HB, Xu D, Sun XF, Li XT, Zhang XY, Wang K, Xing BC, Sun YS. Prediction of hepatic lymph node metastases based on magnetic resonance imaging before and after preoperative chemotherapy in patients with colorectal liver metastases underwent surgical resection. Cancer Imaging 2023;23:18. [PMID: 36810192 PMCID: PMC9942330 DOI: 10.1186/s40644-023-00529-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023] Open

Affiliation(s)

Hai-bin Zhu grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
Da Xu grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
Xue-Feng Sun grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
Xiao-Ting Li grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
Xiao-Yan Zhang grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142 China
Kun Wang Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
Bao-Cai Xing Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Hepatopancreatobiliary Surgery Department I, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
Ying-Shi Sun Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital & Institute, 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.

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Tham E, Sestito M, Markovich B, Garland-Kledzik M. Current and future imaging modalities in gastric cancer. J Surg Oncol 2022;125:1123-1134. [PMID: 35481912 DOI: 10.1002/jso.26875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 12/24/2022]

Xu H, Zhao W, Guo W, Cao S, Gao C, Song T, Yang L, Liu Y, Han Y, Zhang L, Wang K. Prediction Model Combining Clinical and MR Data for Diagnosis of Lymph Node Metastasis in Patients With Rectal Cancer. J Magn Reson Imaging 2020;53:874-883. [PMID: 32978993 DOI: 10.1002/jmri.27369] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/29/2020] [Accepted: 09/01/2020] [Indexed: 12/31/2022] Open

Abstract

BACKGROUND

Determining the status of lymph node (LN) metastasis in rectal cancer patients preoperatively is crucial for the treatment option. However, the diagnostic accuracy of current imaging methods is low.

PURPOSE

To develop and test a model for predicting metastatic LNs of rectal cancer patients based on clinical data and MR images to improve the diagnosis of metastatic LNs.

STUDY TYPE

Retrospective.

SUBJECTS

In all, 341 patients with histologically confirmed rectal cancer were divided into one training set (120 cases) and three validation sets (69, 103, 49 cases).

FIELD STRENGTH/SEQUENCE

3.0T, axial and sagittal T₂ -weighted turbo spin echo and diffusion-weighted imaging (b = 0 s/mm² , 800 s/mm² ) ASSESSMENT: In the training dataset, univariate logistic regression was used to identify the clinical factors (age, gender, and tumor markers) and MR data that correlated with LN metastasis. Then we developed a prediction model with these factors by multiple logistic regression analysis. The accuracy of the model was verified using three validation sets and compared with the traditional MRI method.

STATISTICAL TESTS

Univariate and multivariate logistic regression. The area under the curve (AUC) value was used to quantify the diagnostic accuracy of the model.

RESULTS

Eight factors (CEA, CA199, ADCmean, mriT stage, mriN stage, CRM, EMVI, and differentiation degree) were significantly associated with LN metastasis in rectal cancer patients (P<0.1). In the training set (120) and the three validation sets (69, 103, 49), the AUC values of the model were much higher than the diagnosis by MR alone (training set, 0.902 vs. 0.580; first validation set, 0.789 vs. 0.743; second validation set, 0.774 vs. 0.573; third validation set, 0.761 vs. 0.524).

DATA CONCLUSION

For the diagnosis of metastatic LNs in rectal cancer patients, our proposed logistic regression model, combining clinical and MR data, demonstrated higher diagnostic efficiency than MRI alone.

LEVEL OF EVIDENCE

4 TECHNICAL EFFICACY STAGE: 2.

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Renzulli M, Clemente A, Spinelli D, Ierardi AM, Marasco G, Farina D, Brocchi S, Ravaioli M, Pettinari I, Cescon M, Reginelli A, Cappabianca S, Carrafiello G, Golfieri R. Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging? Cancers (Basel) 2020;12:1402. [PMID: 32485933 PMCID: PMC7352169 DOI: 10.3390/cancers12061402] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 12/13/2022] Open

Abstract

Gastric cancer (GC) is a common cancer worldwide. Its incidence and mortality vary depending on geographic area, with the highest rates in Asian countries, particularly in China, Japan, and South Korea. Accurate imaging staging has become crucial for the application of various treatment strategies, especially for curative treatments in early stages. Unfortunately, most GCs are still diagnosed at an advanced stage, with the peritoneum (61-80%), distant lymph nodes (44-50%), and liver (26-38%) as the most common metastatic locations. Metastatic disease is limited to the peritoneum in 58% of cases; in nonperitoneal distant metastases, the most involved GC metastasization site is the liver (82%). The eighth edition of the tumor-node-metastasis staging system is the most commonly used system for determining GC prognosis. Endoscopic ultrasonography, computed tomography, and 18-fluorideoxyglucose positron emission tomography are historically the most accurate imaging techniques for GC staging. However, studies have recently shown renewed interest in magnetic resonance imaging (MRI) as a useful tool in GC staging, especially for distant metastasis assessment. The technical improvement of diffusion-weighted imaging and the increasing use of hepatobiliary contrast agents have been shown to increase the diagnostic performance of MRI, particularly for detecting peritoneal and liver metastasis. However, no principal oncological guidelines have included the use of MRI as a first-line technique for distant metastasis evaluation during the GC staging process, such as the National Comprehensive Cancer Network Guidelines. This review analyzed the role of the principal imaging techniques in GC diagnosis and staging, focusing on the potential role of MRI, especially for assessing peritoneal and liver metastases.

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Affiliation(s)

Matteo Renzulli Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
Alfredo Clemente Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
Daniele Spinelli Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
Anna Maria Ierardi Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.M.I.); (G.C.)
Giovanni Marasco Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy;
Davide Farina Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25138 Brescia, Italy;
Stefano Brocchi Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
Matteo Ravaioli General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (M.R.); (M.C.)
Irene Pettinari Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)
Matteo Cescon General and Transplant Surgery Unit, Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy; (M.R.); (M.C.)
Alfonso Reginelli Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
Salvatore Cappabianca Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (A.C.); (A.R.); (S.C.)
Gianpaolo Carrafiello Diagnostic and Interventional Radiology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milan, Italy; (A.M.I.); (G.C.)
Rita Golfieri Radiology Unit, Department of Experimental, Diagnostic and Speciality Medicine, Sant’Orsola Hospital, University of Bologna, 40138 Bologna, Italy; (D.S.); (S.B.); (I.P.); (R.G.)

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Zhang Y, Yu J. The role of MRI in the diagnosis and treatment of gastric cancer. Diagn Interv Radiol 2020;26:176-182. [PMID: 32209504 PMCID: PMC7239361 DOI: 10.5152/dir.2019.19375] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]

Soydan L, Demir AA, Torun M, Cikrikcioglu MA. Use of Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient in Gastric Cancer Staging. Curr Med Imaging 2020;16:1278-1289. [PMID: 32108000 DOI: 10.2174/1573405616666200218124926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/08/2020] [Accepted: 01/23/2020] [Indexed: 11/22/2022]

Abstract

BACKGROUND

The apparent diffusion coefficient (ADC), the quantitative parameter of diffusion-weighted magnetic resonance imaging (DW-MRI), is a measure for this restricted diffusion, and its role in gastric cancer (GC) including distinguishing malignant segments from healthy gastric wall, metastatic perigastric lymph nodes from benign nodes and evaluating response of GC to neoadjuvant chemotherapy has been investigated in previous studies. Evidence suggests that ADC may also be of help in assessment of aggressiveness and preoperative staging of gastric cancer, which needs to be explored in further studies.

OBJECTIVE

To investigate the role of DW-MRI and its quantitative parameter, ADC in staging of gastric cancer.

METHODS

Forty-six patients (28 male, 18 female, mean age 62 years) with non-metastatic biopsy- proven GC who underwent abdominal DW-MRI before surgery were included in this retrospective study. Tumor invasion depth (T-stage) and nodal involvement (N-stage) were evaluated using signal increase on DW-MRI, and tumor ADC was measured. Diagnostic performance of these results was assessed by comparing them with postsurgical histopathology based on 8th TNM classification.

RESULTS

Sensitivity, specificity, and accuracy of DW-MRI in T-staging were 92.1%, 75%, 89.1% for ≤T2 vs. ≥T3; and 75%, 88.5%, 82.6% for ≤T3 vs. T4. However, sensitivity, specificity, and accuracy of DW-MRI in N-staging were 89.3%, 88.9%, 89.1% for ≤N1 vs. ≥N2; and 73.7%, 96.3%, 86.9% for ≤N2 vs. N3, respectively. Relative preoperative ADC values correlated with pT staging (r=-0.397, p=0.006). There was also a statistically significant difference of relative ADC values between ≤T3 and T4 stages, and a cut-off of 0.64 s/mm2 could differentiate these stages with an odds ratio of 7.714 (95% confidence interval, 1.479-40.243). The area under the receiver operating characteristic curve for differentiating ≤T3 and T4 stages was 0.725.

CONCLUSION

DW-MRI may contribute to the clinical staging of non-metastatic GC. In particular, relative ADC of DW-MRI can distinguish T4 gastric cancer from less advanced T-stages.

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Huang TX, Lu N, Lian SS, Li H, Yin SH, Geng ZJ, Xie CM. The primary lesion apparent diffusion coefficient is a prognostic factor for locoregionally advanced nasopharyngeal carcinoma: a retrospective study. BMC Cancer 2019;19:470. [PMID: 31101029 PMCID: PMC6525458 DOI: 10.1186/s12885-019-5684-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 05/08/2019] [Indexed: 01/21/2023] Open

Borggreve AS, Goense L, Brenkman HJF, Mook S, Meijer GJ, Wessels FJ, Verheij M, Jansen EPM, van Hillegersberg R, van Rossum PSN, Ruurda JP. Imaging strategies in the management of gastric cancer: current role and future potential of MRI. Br J Radiol 2019;92:20181044. [PMID: 30789792 DOI: 10.1259/bjr.20181044] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open

Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases. Eur J Surg Oncol 2019;45:347-352. [DOI: 10.1016/j.ejso.2018.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 12/27/2022] Open

Giganti F, Tang L, Baba H. Gastric cancer and imaging biomarkers: Part 1 - a critical review of DW-MRI and CE-MDCT findings. Eur Radiol 2018;29:1743-1753. [PMID: 30280246 PMCID: PMC6420485 DOI: 10.1007/s00330-018-5732-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 12/17/2022]

Abstract

Abstract

The current standard of care for gastric cancer imaging includes heterogeneity in image acquisition techniques and qualitative image interpretation. In addition to qualitative assessment, several imaging techniques, including diffusion-weighted magnetic resonance imaging (DW-MRI), contrast-enhanced multidetector computed tomography (CE-MDCT), dynamic-contrast enhanced MRI and 18F-fluorodeoxyglucose positron emission tomography, can allow quantitative analysis. However, so far there is no consensus regarding the application of functional imaging in the management of gastric cancer. The aim of this article is to specifically review two promising biomarkers for gastric cancer with reasonable spatial resolution: the apparent diffusion coefficient (ADC) from DW-MRI and textural features from CE-MDCT. We searched MEDLINE/ PubMed for manuscripts published from inception to 6 February 2018. Initially, we searched for (gastric cancer OR gastric tumour) AND diffusion weighted magnetic resonance imaging. Then, we searched for (gastric cancer OR gastric tumour) AND texture analysis AND computed tomography. We collated the results from the studies related to this query. There is evidence that: (1) the ADC is a promising biomarker for the evaluation of the aggressiveness (T and N stage), treatment response and prognosis of gastric cancer; (2) textural features are related to the degree of differentiation, Lauren classification, treatment response and prognosis of gastric cancer. We conclude that these imaging biomarkers hold promise as effective additional tools in the diagnostic pathway of gastric cancer and may facilitate the multidisciplinary work between the radiologist and clinician, and across different institutions, to provide a greater biological understanding of gastric cancer.

Key Points

• Quantitative imaging is the extraction of quantifiable features from medical images for the assessment of normal or pathological conditions and represents a promising area for gastric cancer.

• Quantitative analysis from CE-MDCT and DW-MRI allows the extrapolation of multiple imaging biomarkers.

• ADC from DW-MRI and CE- MDCT-based texture features are non-invasive, quantitative imaging biomarkers that hold promise in the evaluation of the aggressiveness, treatment response and prognosis of gastric cancer.

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Long 龙淼淼 M, Wang 王蕾 L, Mou 牟玲 L, Zhang 张可 K, Liu 刘丽华 L, Li 李艳艳 Y, Liu 刘晓斌 X, Yu 于文娟 W, Gao 高光峰 G, Chen 陈新娟 X, Shen 沈文 W, Shrestha A. Z-Score transformation of ADC values: A way to universal cut off between malignant and benign lymph nodes. Eur J Radiol 2018;106:122-127. [PMID: 30150033 DOI: 10.1016/j.ejrad.2018.07.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 07/08/2018] [Accepted: 07/25/2018] [Indexed: 12/24/2022]

Abstract

PURPOSE

To determine the possibility of a universal cut off value between benign and malignant lymph nodes in patients with tumour by Z-Score transformation method.

MATERIALS AND METHODS

Diffusion weighted imaging, ADC measurements of malignant and benign lymph nodes of 6 studies (4 body parts), conducted for 5 times, in two institutions with variable technical details were analyzed in their original value as well as the standardized Z-Score value. The standardized Z-Score value was obtained by subtracting the population mean of the control group from an individual raw score and then dividing the difference by the population standard deviation of the control group. General cut off values were obtained by both Mega-analysis by receiver operator characteristic curve analysis, when data from the 6 studies were combined and Meta-analysis with weighting coefficients and cut off values of the six individual studies. Sensitivity, specificity and accuracy with cut offs from individual studies, meta-analysis and mega-analysis were calculated. Kappa test was performed to assess the consistency of diagnostic test accuracy, between optimized cut offs of individual studies and the proposed universal cut offs obtained from meta-analysis and mega-analysis.

RESULTS

The ADC values of benign and malignant lymph nodes are significantly different, but with large overlap across the studies. The overlap can be minimized by Z-Score transformation. The result of ROC analysis of the collective Z-Score transformed ADC values of 6 studies was superior to that of the collective original ADC values (sensitivity: 87.4% versus 67.2%, specificity: 90.5% versus 87.9%, accuracy: 89.6% versus 81.4%). The universal Z-Score cut off from Meta-analysis is also better than the original ADC cut off (sensitivity: 82.8% versus 76.3%, specificity 92.6% versus 62.9%, accuracy 89.6% versus 67.1%). Applied to the individual studies, the universal transformed Z-Score cut offs produced superior consistency with the individual optimal cut offs (individual and meta Z-Score: 0.7228-0.9793; individual and mega Z-Score: 0.7111-0.9169) compared with the universal original ADC cut offs (individual and meta ADC: 0.3030-1.0000; individual and mega ADC 0.3268-0.9618).

CONCLUSION

Z-Score transformation could minimize inter-study variations due to heterogeneity of MR systems and sequence parameters, and provide a more consistent universal cut off value between benign and malignant nodes across studies.

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Vergadis C, Schizas D. Is Accurate N - Staging for Gastric Cancer Possible? Front Surg 2018;5:41. [PMID: 29904636 PMCID: PMC5991260 DOI: 10.3389/fsurg.2018.00041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/03/2018] [Indexed: 01/03/2023] Open

Prediction of lateral pelvic lymph node metastasis in patients with locally advanced rectal cancer with preoperative chemoradiotherapy: Focus on MR imaging findings. PLoS One 2018;13:e0195815. [PMID: 29649321 PMCID: PMC5897011 DOI: 10.1371/journal.pone.0195815] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 03/31/2018] [Indexed: 01/11/2023] Open

Comparison of DWI and ¹⁸F-FDG PET/CT for assessing preoperative N-staging in gastric cancer: evidence from a meta-analysis. Oncotarget 2017;8:84473-84488. [PMID: 29137440 PMCID: PMC5663612 DOI: 10.18632/oncotarget.21055] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/08/2017] [Indexed: 12/18/2022] Open

Kong XC, Xiong LY, Gazyakan E, Engel H, Kneser U, Nüssler AK, Hirche C, Kong XQ. Diagnostic power of diffusion-weighted magnetic resonance imaging for the presence of lymph node metastasis: A meta-analysis. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2017;37:469-474. [PMID: 28786054 DOI: 10.1007/s11596-017-1759-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 03/29/2017] [Indexed: 10/18/2022]

Arslan H, Fatih Özbay M, Çallı İ, Doğan E, Çelik S, Batur A, Bora A, Yavuz A, Bulut MD, Özgökçe M, Çetin Kotan M. Contribution of diffusion weighted MRI to diagnosis and staging in gastric tumors and comparison with multi-detector computed tomography. Radiol Oncol 2017;51:23-29. [PMID: 28265229 PMCID: PMC5330170 DOI: 10.1515/raon-2017-0002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 08/24/2016] [Indexed: 12/19/2022] Open

Abstract

Background

Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared.

Patients and methods

We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used.

Results

Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%.

Conclusions

The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.

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Zhong J, Zhao W, Ma W, Ren F, Qi S, Zheng J, Wang X, Lv T, Su Z, Yin H, Ren J, Huan Y. DWI as a Quantitative Biomarker in Predicting Chemotherapeutic Efficacy at Multitime Points on Gastric Cancer Lymph Nodes Metastases. Medicine (Baltimore) 2016;95:e3236. [PMID: 27043694 PMCID: PMC4998555 DOI: 10.1097/md.0000000000003236] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open

Abstract

The purpose of the hypothesis testing is to determine that apparent diffusion coefficient (ADC) as an early biomarker can predict the metastatic lymph nodes' (LNs) response to neoadjuvant chemotherapy in advanced gastric cancer (GC) in early stage. From March 2011 to June 2015, 106 patients with advanced GC were enrolled in the study. Patients underwent conventional magnetic resonance imaging and functional diffusion weighted imaging before and 3 days, 7 days, 30 days, and 60 days following the standard chemotherapy. After surgery, among 3034 detected LNs, the positive group was divided into complete response (CR) group, partial response (PR) group, and stable disease (SD) group in accordance to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Mean ADCs, short/long diameters of LNs before chemotherapy between the whole positive and the negative LNs were compared by t test. Changes of mean ADCs in 3 groups were analyzed by 1-way ANOVA. The mean ADC of the whole positive LNs was (1.145 ± 0.014) × 10⁻³ mm²/s, which was significantly lower than that of the whole negative LNs ([1.491 ± 0.010] × 10⁻³ mm²/s; P < 0.05). The means of both short/long diameters in the whole positive LNs were significantly longer than those in the whole negative LNs (P < 0.05). In CR, PR, and SD groups, the mean ADC of metastatic LNs on the 3rd day, 7th day, 13th day, and 16th day following the chemotherapy were all higher than that of LNs before chemotherapy, respectively (all P < 0.05). In addition, significant difference was found between mean ADCs in any 2 time points (all P < 0.05), except between mean ADCs in the 3rd day and in the 7th day of the chemotherapy. In conclusion, ADC can be used as an early biomarker to predict the metastatic LNs' response to neoadjuvant chemotherapy in advanced GC in early stage.

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Mao Y, Hedgire SS, Liao G, Lv F, Li Y, Li Q, Wang Z. Topographic distribution and characteristics of normal gastric regional lymph nodes on diffusion-weighted magnetic resonance imaging. Acta Radiol 2016;57:152-61. [PMID: 25735622 DOI: 10.1177/0284185115574736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 01/31/2015] [Indexed: 01/11/2023]

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De Robertis R, Tinazzi Martini P, Demozzi E, Dal Corso F, Bassi C, Pederzoli P, D’Onofrio M. Diffusion-weighted imaging of pancreatic cancer. World J Radiol 2015;7:319-328. [PMID: 26516428 PMCID: PMC4620112 DOI: 10.4329/wjr.v7.i10.319] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/27/2015] [Accepted: 08/28/2015] [Indexed: 02/06/2023] Open

He J, Shi H, Zhou Z, Chen J, Guan W, Wang H, Yu H, Liu S, Zhou Z, Yang X, Liu T. Correlation between apparent diffusion coefficients and HER2 status in gastric cancers: pilot study. BMC Cancer 2015;15:749. [PMID: 26487555 PMCID: PMC4618135 DOI: 10.1186/s12885-015-1726-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 10/08/2015] [Indexed: 12/23/2022] Open

Liu S, Wang H, Guan W, Pan L, Zhou Z, Yu H, Liu T, Yang X, He J, Zhou Z. Preoperative apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: Correlations with postoperative TNM staging. J Magn Reson Imaging 2015;42:837-843. [PMID: 25581898 DOI: 10.1002/jmri.24841] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 12/15/2014] [Indexed: 12/19/2022] Open

Abdel Razek AAK, Gaballa G, Elashry R, Elkhamary S. Diffusion-weighted MR imaging of mediastinal lymphadenopathy in children. Jpn J Radiol 2015;33:449-54. [PMID: 26067466 DOI: 10.1007/s11604-015-0434-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 05/02/2015] [Indexed: 12/16/2022]

Hasbahceci M, Akcakaya A, Memmi N, Turkmen I, Cipe G, Yildiz P, Arici DS, Muslumanoglu M. Diffusion MRI on lymph node staging of gastric adenocarcinoma. Quant Imaging Med Surg 2015;5:392-400. [PMID: 26029642 DOI: 10.3978/j.issn.2223-4292.2015.03.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 03/06/2015] [Indexed: 12/14/2022]

Affiliation(s)

Mustafa Hasbahceci 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Adem Akcakaya 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Naim Memmi 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Ihsan Turkmen 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Gokhan Cipe 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Pelin Yildiz 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Dilek Sema Arici 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey
Mahmut Muslumanoglu 1 Department of General Surgery, 2 Department of Radiology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey ; 3 Department of General Surgery, Fatih University Faculty of Medicine, Fatih, Istanbul 34500, Turkey ; 4 Department of Pathology, Bezmialem Vakif University Faculty of Medicine, Fatih, Istanbul 34093, Turkey

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Razek AAKA, Lattif MA, Denewer A, Farouk O, Nada N. Assessment of axillary lymph nodes in patients with breast cancer with diffusion-weighted MR imaging in combination with routine and dynamic contrast MR imaging. Breast Cancer 2015;23:525-32. [PMID: 25763535 DOI: 10.1007/s12282-015-0598-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/21/2015] [Indexed: 12/27/2022]

Liu S, Guan W, Wang H, Pan L, Zhou Z, Yu H, Liu T, Yang X, He J, Zhou Z. Apparent diffusion coefficient value of gastric cancer by diffusion-weighted imaging: correlations with the histological differentiation and Lauren classification. Eur J Radiol 2014;83:2122-2128. [PMID: 25442484 DOI: 10.1016/j.ejrad.2014.09.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/03/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]

Evaluation of lateral pelvic nodes in patients with advanced rectal cancer. AJR Am J Roentgenol 2014;202:1245-55. [PMID: 24848821 DOI: 10.2214/ajr.13.11228] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]