| Objective: To evaluate the diagnositic value of diffusion-weighted Imaging (DWI) to differentiate malignant and reactive hyperplasia pelvic lymph node in patients with cervical carcinoma before the first treatment.Materials and Methods: 53 untreated patients with cervical carcinoma were performed with both conventional MR and DWI. The bilateral pelvic lymphadenectomy was performed in all patients. Of the total dissected and histopathologically evaluated 1178 pelvic lymph nodes, nodes(108 nodes) with short-axis diameter larger than 0.5cm were divided into metastatic (49 nodes) and reactive hyperplasia(59 nodes) groups. The signal intensity of the lymph nodes was assessed on images obtained at b=0 or 800s/mm2 and from the ADC maps and the eADC maps. The ADC value and eADC value of lymph nodes were also measured and respectively compared between metastatic and reactive hyperplasia lymph nodes.Rusults: The mean ADC value of malignant [(1.072±0.185)×10-3mm2/s] lymph nodes was significantly lower than that of reactive hyperplasia [(1.281±0.253)×10-3mm2/s] lymph nodes (P = 0. 000).The maximum ADC value of malignant [(1.488±0.263)×10-3mm2/s] lymph nodes was significantly lower than that of reactive hyperplasia [(2.024±0.445)×10-3mm2/s] lymph nodes (P = 0. 000).The mean eADC value of malignant [(0.351±0.059)×10-3mm2/s] lymph nodes was significantly higher than that of reactive hyperplasia [(0.297±0.076)×10-3mm2/s] lymph nodes (P = 0. 000).The minimum eADC value of malignant [(0.231±0.054)×10-3mm2/s] lymph nodes was significantly higher than that of reactive hyperplasia [(0.145±0.065)×10-3mm2/s] lymph nodes (P = 0. 000).The minimum ADC value between malignant and reactive hyperplasia lymph nodes showed no statistical significance (P = 0. 061). The maximum eADC value between malignant and reactive hyperplasia lymph nodes showed no statistical significance (P = 0. 180). When a mean ADC value of 1.11×10-3mm2/s was used as a threshold value for differentiating metastatic from reactive hyperplasia lymph nodes with short-axis diameter larger than 0.5cm, the best results were obtained with a sensitivity of 71%, specificity of 78% and accuracy of 75%. When a maximum ADC value of 1.83×10-3mm2/s was used as a threshold value for differentiating metastatic from reactive hyperplasia lymph nodes with short-axis diameter larger than 0.5cm, the best results were obtained with a sensitivity of 92%, specificity of 75% and accuracy of 82%.Conclosion:1 DWI provides a new method for detection of malignant lymph node in patients with cervical carcinoma.2 The calculation of ADC value and eADC value is signinficant for differntiating malignant and reacitive hyperplasia pelvic lymph nodes in patients with cervical carcinoma.3 The maximum ADC value is more sensitive for differntiating malignant and reacitive hyperplasia pelvic lymph nodes in patients with cervical carcinoma than the mean ADC value. |
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