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Evaluation of the diagnostic performance of apparent diffusion coefficient (ADC) values on diffusion-weighted magnetic resonance imaging (DWI) in differentiating between benign and metastatic lymph nodes in cases of cholangiocarcinoma

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Abstract

Introduction

Cholangiocarcinoma (CCA) is the primary tumor found in the bile duct and is associated with a high incidence of lymph node (LN) metastases and poor outcomes. The presence of metastatic lymph nodes, when shown by imaging, can influence patient treatment and prognosis. DWI is a promising, non-invasive imaging technique for differentiating between benign and malignant LNs. Many studies have shown that LN metastases have a lower apparent diffusion coefficient (ADC) value when compared to benign nodes.

Objective

To evaluate the performance of ADC values as a basis for diagnosis of LN metastasis in cholangiocarcinoma patients.

Materials and methods

This was a retrospective imaging study that evaluated histopathologically proven intraabdominal LNs in cholangiocarcinoma patients who underwent a 1.5T abdomen MRI with DWI between January 2012 and July 2016. The ADC values and short-axis diameters of the LNs were measured and compared using student’s t test. Receiver operating characteristic (ROC) curves were used to determine the threshold.

Results

A total of 120 lymph nodes—85 benign and 35 metastatic—were included. The mean short-axis diameter of the benign LNs (8.34 mm) was significantly lesser than that of the malignant LNs (9.56 mm). Receiver operating characteristic curve analysis using a size criterion of 1 cm yielded a value of 0.63. A diagnostic size criterion of 1 cm for the short axis was applied and yielded an accuracy of 66%, sensitivity/specificity of 41%/75%, and positive/negative predictive value of 34%/80%. The mean ADC values of metastatic (1.31 × 10−3 mm2/s) LNs were not significantly different from those of non-metastatic LNs (1.29 × 10−3 mm2/s).

Conclusion

There was no difference in terms of ADC value between benign lymph nodes and those with metastatic cholangiocarcinoma. Isolated measurement of the ADC value does not contribute to a diagnosis of lymph node metastasis.

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Acknowledgements

We would like to acknowledge Dylan Southard (Research Affairs, Faculty of Medicine, Khon Kaen University, Thailand) for editing the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Julaluck Promsorn, Wannaporn Soontrapa, Kulyada Somsap & Nittaya Chamadol

  2. Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Panita Limpawattana

  3. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA

    Mukesh Harisinghani

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  1. Julaluck Promsorn
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Correspondence to Julaluck Promsorn.

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Funding

This study was funded by Faculty of Medicine Khon Kaen University, Thailand (Grant Number IN60110).

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of retrospective study, formal consent is not required.

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Promsorn, J., Soontrapa, W., Somsap, K. et al. Evaluation of the diagnostic performance of apparent diffusion coefficient (ADC) values on diffusion-weighted magnetic resonance imaging (DWI) in differentiating between benign and metastatic lymph nodes in cases of cholangiocarcinoma. Abdom Radiol 44, 473–481 (2019). https://doi.org/10.1007/s00261-018-1742-6

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