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


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.


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


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


  1. Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A (2006). Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol, 16, 1468-77.
  2. Cheran SK, Nielsen ND, Patz EF (2004). False-negative findings for primary lung tumors on FDG positron emission tomography. Staging and prognostic implications. AJR, 182, 1129-32.
  3. Chong S, Lee KS, Chung MJ, et al (2006). Pneumoconiosis. Comparison of imaging and pathologic findings. Radiographics, 26, 59-77.
  4. Desprechins B, Stadnik T, Koerts G, et al (1999). Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. Am J Neuroradiol, 20, 1252-7.
  5. Feuerlein S, Pauls S, Juchems MS, et al (2009). Pitfalls in abdominal diffusion-weighted imaging. How predictive is restricted water diffusion for malignancy. AJR, 193, 1070-6.
  6. Goo JM, Im JG, Do KH, et al (2000). Pulmonary tuberculoma evaluated by means of FDG PET. Findings in 10 cases. Radiol, 216, 117-21.
  7. Higashi K, Ueda Y, Seki H, et al (1998). Fluorine-18-FDG PET imaging is negative in bronchioloalveolar lung carcinoma. J Nucl Med, 39, 1016-20.
  8. Humphries PD, Sebire NJ, Sieel MJ, Olsen OE. (2007) Tumors in pediatric patients at diffusion-weighted MR imaging. Apparent diffusion coefficient and tumor cellularity. Radiol, 245, 848-54.
  9. Jain V, Hasselquist S, Delaney MD (2011). PET scanning in sarcoidosis. Ann N Y Acad Sci, 1228, 46-58.
  10. Koksal D, Demirag F, Bayiz H, et al ( 2013). The correlation of SUVmax with pathological characteristics of primary tumor and the value of tumor/ lymph node SUVmax ratio for predicting metastasis to lymph nodes in resected NSCLC patients. J Cardiothorac Surg, 8, 63.
  11. Konishi J, Yamazaki K, Tsukamoto E, et al ( 2003). Mediastinal lymph node staging by FDG-PET in patients with nonsmall cell lung cancer: analysis of false-positive FDG-PET findings. Respirat, 70, 500-6.
  12. Kosucu P, Tekinbas C, Erol M, et al (2009). Mediastinal lymph nodes. assessment with diffusion-weighted MR imaging. J Magn Reson Imaging, 30, 292-7.
  13. Kwee TC, Takahara T, Ochiai R, et al (2010). Complementary roles of whole-body diffusion-weighted MRI and 18F-FDG PET. The state of the art and potential application. J Nucl Med, 51, 1549-58.
  14. Le Bihan D, Breton E, Lallemand D, et al (1988). Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiol, 168, 497-505.
  15. Lin WY, Hsu WH, Lin KH, Wang SJ (2012). Role of preoperative PET-CT in assessing mediastinal and hilar lymph node status in early stage lung cancer. J Chin Med Assoc, 75, 203-8.
  16. Maturu VN, Agarwal R, Aggarwal AN, et al (2014). Dualtime point whole-body 18F-fluorodeoxyglucose PET/CT imaging in undiagnosed mediastinal lymphadenopathy: a prospective study of 117 patients with sarcoidosis and TB. Chest, 146, 216-20.
  17. Nasu K, Kuroki Y, Kuroki S, et al (2004). Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique. Jpn J Clin Oncol, 34, 620-6.
  18. Nomori H, Mori T, Ikeda K, et al (2008). Diffusion-weighted magnetic resonance imaging can be used in place of positron emission tomography for N staging of non-small cell lung cancer with fewer false-positive results. J Thoracic Cardiovasc Surg, 135, 816-22.
  19. Nomori H, Watanabe K, Ohtsuka T, et al (2004). Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3cm in diameter, with special reference to the CT images. Lung cancer, 45,19-27.
  20. Perrone A, Guerrisi P, Izzo L, et al (2011). Diffusion-weighted MRI in cervical lymph nodes: differentiation between benign and malignant lesions. Eur J Radiol, 77, 281-6.
  21. Saydam O, Gokce M, Kilicgun A, Tanriverdi O (2012). Accuracy of positron emission tomography in mediastinal node assessment in coal workers with lung cancer. Med Oncol, 29, 589-94.
  22. Schaefer PW, Grant PE, Gonzalez RG (2000). Diffusionweighted MR imaging of the brain. Radiol, 217, 331-45.
  23. Sorensen AG, Buonanno FS, Gonzalez RG, et al (1996). Hyperacute stroke. Evaluation with combined multisection diffusion-weighted and hemodynamically weighted echoplanar MR imaging. Radiol, 199, 391-401.
  24. Szafer A, Zhong J, Gore JC (1995). Theoretical model for water diffusion in tissues. Magn Reson Med, 33, 697-712.
  25. Takahara T, Imai Y, Yamashita T, et al (2004). Diffusion weighted whole body imaging with background body signal suppression (DWIBS). Technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med, 22, 275-82.
  26. Tien RD, Felsberg GJ, Friedman H, Brown M, MacFall J (1994). MR imaging of high-grade cerebral gliomas. Value of diffusion-weighted echoplanar pluse sequences. AJR, 162, 671-7.
  27. Usuda K, Sagawa M, Motono N, et al (2013). Advantages of diffusion-weighted imaging over positron emission tomography-computed tomography in assessment of hilar and mediastinal lymph node in lung cancer. Ann Surg Oncol, 20, 1676-83.
  28. Usuda K, Sagawa M, Motono N, et al (2014). Diagnostic performance of diffusion weighted imaging of malignant and benign pulmonary nodules and masses. Comparison with positron emission tomography. Asian Pac J Cancer Prev, 15, 4629-35.
  29. Usuda K, Zhao XT, Sagawa M, et al (2011). Diffusion-weighted imaging is superior to PET in the detection and nodal assessment of lung cancers. Ann Thorac Surg, 91, 1689-95.
  30. Xue HD, Li S, Sun HY, Jin ZY, Sun F (2008). Experimental study of inflammatory and metastatic lymph nodes with diffusion weighted imaging on animal model: comparison with conventional methods. Chin Med Sci J. 23, 166-71.

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