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Diagnostic Performance of Diffusion - Weighted Imaging for Multiple Hilar and Mediastinal Lymph Nodes with FDG Accumulation

  • Usuda, Katsuo (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Maeda, Sumiko (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Motono, Nozomu (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Ueno, Masakatsu (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Tanaka, Makoto (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Machida, Yuichiro (Department of Thoracic Surgery, Kanazawa Medical University) ;
  • Matoba, Munetaka (Department of Radiology, Kanazawa Medical University) ;
  • Watanabe, Naoto (Department of Radiology, Kanazawa Medical University) ;
  • Tonami, Hisao (Department of Radiology, Kanazawa Medical University) ;
  • Ueda, Yoshimichi (Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University) ;
  • Sagawa, Motoyasu (Department of Thoracic Surgery, Kanazawa Medical University)
  • Published : 2015.10.06

Abstract

Background: It is sometimes difficult to assess patients who have multiple hilar and mediastinal lymph nodes (MHMLN) with FDG accumulation in PET-CT. Since it is uncertain whether diffusion-weighted magnetic resonance imaging (DWI) is useful in the assessment of such patients, its diagnostic performance was assessed. Materials and Methods: Twenty-three patients who had three or more stations of hilar and mediastinal lymph nodes with SUVmax of 3 or more in PET-CT were included in this study. Results: For diagnosis of disease, there were 20 malignancies (lung cancers 17, malignant lymphomas 2 and metastatic lung tumor 1), and 3 benign cases (sarcoidosis 2 and benign disease 1). For diagnosis of lymph nodes, there were 7 malignancies (metastasis of lung cancer 7 and malignant lymphoma 1) and 16 benign lymphadenopathies (pneumoconiosis/silicosis 7, sarcoidosis 4, benign disease 4, and atypical lymphocyte infiltration 1). The ADC value ($1.57{\pm}0.29{\times}10^{-3}mm^2/sec$) of malignant MHMLN was significantly lower than that ($1.99{\pm}0.24{\times}10^{-3}mm^2/sec$) of benign MHMLN (P=0.0437). However, the SUVmax was not significantly higher ($10.0{\pm}7.34$ as compared to $6.38{\pm}4.31$) (P=0.15). The sensitivity (86%) by PET-CT was not significantly higher than that (71%) by DWI for malignant MHMLN (P=1.0). The specificity (100%) by DWI was significantly higher than that (31%) for benign MHMLN (P=0.0098). Furthermore, the accuracy (91%) with DWI was significantly higher than that (48%) with PET-CT for MHMLN (P=0.0129). Conclusions: Evaluation by DWI for patients with MHMLN with FDG accumulation is useful for distinguishing benign from malignant conditions.

Keywords

Diffusion-weighted imaging;magnetic resonance imaging;PET;lymph nodes

Acknowledgement

Supported by : Ministry of Education, Culture, Sports, Science and Technology

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