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Comparison Between Malignant and Benign Abdominal Lymph Nodes on Diffusion-weighted Imaging

Posted Apr 30, 2008 Updated Apr 7, 2023
By E. Isin Akduman MD , Amir Javad Momtahen MD , N. Cem Balci MD , Namit Mahajann MD , Necat Havlioglu MD PhD , Michael K. Wolverson MD
6 min read

Rationale and Objectives

The purpose of this study is to review the apparent diffusion coefficient (ADC) values of benign and metastatic abdominal lymph nodes on diffusion-weighted imaging (DWI).

Materials and Methods

Twenty-eight patients with a total of 40 benign (20 patients) and 16 malignant (8 patients) lymph nodes who underwent DWI MRI of the abdomen (b = 0.600) were enrolled in the study. ADC values of the lymph nodes were measured and comparison was made between benign and malignant groups.

Results

Mean ADC value of lymph nodes was 2.38 ± 0.29 and 1.84 ± 0.37 × 10 −3 mm 2 /sec in the benign and malignant groups, respectively. There was a significant statistical difference between the ADC values of benign and malignant lymph nodes ( P < .0005).

Conclusion

A wide range of ADC values exist in patients with metastatic abdominal lymph nodes, with a tendency of higher ADC values in benign lymph nodes.

Evaluation of lymph node metastases is important for oncologic staging. Histopathologic analysis is the most accurate way to determine the composition of lymph nodes and can differentiate between benign and malignant involvement. Tissue sampling can be very challenging in the abdomen and inadequate samples are not uncommon. This may lead to false-negative results ( ). Imaging has been used for staging of oncology patients, including lymph node assessment. Lymph nodes can be detected on imaging by their increased size, but standard imaging modalities may be indeterminate for the nature of enlargement. Positron emission tomography (PET) and single-photon emission computed tomography have been used to differentiate benign from malignant lymph nodes according to the amount of radioactive tracer uptake ( ). Despite their increased specificity, false-negative and false-positive diagnoses may occur. Diffusion-weighted imaging (DWI) has been used in oncologic imaging for the depiction and characterization of tumors as well as differentiating benign from malignant lesions ( ). In this study, we reviewed the apparent diffusion coefficient (ADC) values of lymph nodes visualized on routine abdomen MRI images and their relationship with the final clinical diagnosis.

Materials and methods

Patients

This study was performed retrospectively and is Health Insurance Portability and Accountability Act–compliant. The institutional review board approved the study and waived the requirement for informed consent for the retrospective patient data review. After a review of medical, radiologic, and pathologic records obtained between September 2004 and January 2007 in our institution, 28 patients with reported abdominal lymph nodes on MRI were included in the study who had their final diagnoses determined by histopathology, integrated 18 F-fluoro-2-deoxyglucose (FDG) PET computed tomography (CT), or follow-up imaging. Time interval between final diagnosis and MRI was no longer than 4 weeks in all of the malignant cases. None of the patients in the malignant group had been treated for their diseases prior to imaging.

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Imaging

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Image Analysis

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Statistical Analysis

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Results

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Table 1

Locations, Size, and ADC Value of Benign Lymph Nodes

Underlying Disease Locations Mean Diameter (mm) Mean ADC ⁎ Short Axis Long Axis Hepatitis C Celiac, celiac 8.7 11.2 2.92 Hepatitis C Portacaval, hepatic hilar 12.0 17.3 2.18 Chronic pancreatitis Pyloric, peripancreatic 11.7 14.0 2.42 Hepatitis B and C Hepatic hilar 8.5 13.9 2.02 Hepatitis C Portacaval, celiac, celiac 16.1 22.0 2.22 NASH Periportal, periportal, periportal 10.9 22.1 2.28 PSC Hepatic, celiac, hepatic 12.0 20.3 2.49 Chronic pancreatitis SMA node 10.0 12.0 2.57 Chronic pancreatitis SMA node 8.4 8.8 2.09 Chronic pancreatitis SMA node 11.6 16.0 2.02 Granulomatous hepatitis Hepatic hilar, hepatic, hepatic, portacaval 11.5 15.5 2.09 Chronic pancreatitis Pyloric, paraaortic 17.0 28.5 2.04 PBC Celiac, celiac, hepatic hilar, hepatic hilar 9.4 12.7 2.34 Hepatitis C Portacaval 15.8 18.4 2.81 Hepatitis C Portacaval 9.2 18.4 2.27 Crohn’s disease Mesenteric 12.9 15.8 2.56 Hepatitis C Celiac, hepatic hilar 9.6 14.4 2.80 Hepatitis B Celiac, hepatic hilar 11.8 17.0 2.76 Hepatitis C Celiac, portacaval, hepatic hilar 10.6 15.3 2.19 Hepatitis C Hepatic 9.1 13.5 2.48

ADC, apparent diffusion coefficient; NASH, nonalcoholic steato hepatitis; SMA, superior mesenteric artery; PBC, primary biliary cirrhosis.

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Table 2

Locations, Size, and ADC Value of Malignant Lymph Nodes

Underlying Disease Location Mean Diameter (mm) Mean ADC ⁎ Short Axis Long Axis Esophageal small-cell carcinoma Gastric 21.8 32.2 2.31 Hepatocellular carcinoma Paraaortic, paracaval 19.2 22.8 1.78 Lung cancer (small cell) Paraaortic, juxtaphrenic, left gastric 12.7 14.6 1.66 Cholangiocarcinoma Hepatic hilar 11.6 11.6 1.98 Pancreatic adenocarcinoma Celiac, celiac 12.1 14.9 1.26 Gastrinoma Paraaortic, paraaortic 13.7 15.8 1.44 Pancreatic adenocarcinoma Paraaortic, paraaortic, celiac 8.9 10.2 2.16 Renal cell carcinoma Retrocrural, paraaortic 16.1 19.7 2.13

ADC = apparent diffusion coefficient.

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Figure 1, A 64-year-old male with chronic liver disease. On T2-weighted, fat-saturated, single-shot fast spin echo image (repetition time/echo time; ∞/80 ms), periportal lymph nodes are noted (arrows, a ). On diffusion-weighted image (repetition time/echo time; 1,500/66; b = 600 sec/mm 2 ), lymph nodes are hyperintense (arrows, b ). The colored apparent diffusion coefficient map reveals apparent diffusion coefficient–related color of the lymph nodes (arrows, c ).

Figure 2, A 52-year-old male with hepatocellular carcinoma and lymph node metastasis. T2-weighted, fat-saturated, single-shot fast spin echo image (repetition time/echo time; ∞/80 ms) reveals a left para-aortic lymph node (arrow, a ). On diffusion-weighted image (repetition time/echo time; 1,500/66; b = 600 sec/mm 2 ), the lymph node is hyperintense (arrow, b ). The colored apparent diffusion coefficient map shows its apparent diffusion coefficient–related color (arrow, c ). The positron emission tomographic–computed tomographic image of the same patient reveals 18 F-fluoro-2-deoxyglucose uptake of the lymph node (arrow, d ). Histopathology specimen from fine-needle aspiration (hematoxylin and eosin stain, original magnification, 400×) shows findings compatible with hepatocellular carcinoma infiltration (e) .

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Discussion

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Academic Radiology, Volume 15, Issue 5
Journals General Radiology
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