MRI Diffusion Weighted Imaging Evaluation Of Mediastinal Lymph Node Metastasis Of Esophageal Cancer Clinical Research

Objective1.To investigate the evaluate of magnetic resonance diffusion-weighted imaging（DWI） in detecting mediastinal lymph node metastasis of esophageal cancer.2.To explore the difference of ADC values between benign and malignantmediastinal lymph nodes.Materials and MethodsTo analysis45patients of our hospital who proposed surgical treatment andunderwent magnetic resonance diffusion-weighted imaging within a week beforesurgery. Preoperative esophagoscopy or gastroscopy brush cytology or biopsyconfirmed or suspicious squamous cell carcinoma. Patients before surgery withoutany anti-cancer therapy and have a complete, accurate clinical and pathological data.45patients underwent MRI and DWI within a week before surgery, usedPHILIPS Achieva3.0T MR scan. Scanning parameters:1） cross-sectional T1WI:TR/TE=10/2ms, Thick/spacing=4/1mm, FOV=375mm, matrix=352x160;2）cross-sectional T2WI: TR/TE=1.5s/80ms, Thick/spacing=4/1mm, FOV=375mm,matrix=352x160;3） cross-sectional SPAIR: TR/TE=1.4s/70ms, Thick/spacing=4/1mm, FOV,375mm, matrix=352x160;4）coronal T2WI: TR/TE=1.8s/80ms,Thick/spacing=4/1mm, FOV=375mm, matrix=352x160;5） DWI:TR/TE=2.6s/52ms, Thick/spacing=4/1mm, FOV=375mm, matrix=352x160, b= 0,200s/mm2,400s/mm2,600s/mm2,800s/mm2. Scan range from the cervicalvertebral body4edge to edge of lumbar vertebral body2. Scan by scanning feetwearing overshoes, head wearing headphones, take supine position, and your arms onyour side, put body coil, fixed, foot to head into the main field, scan applicationrespiratory gating equipment at the same time.Application Philips digital diagnostic imaging workstation, the use of the imagereading function observed lymph node shape, size, signal strength and ADC values.Independently by two physicians and reading the results objection discuss consensusas the final result.DWI diagnostic criteria：lymph node groups, and the metastatic lymph nodes inesophageal cancer surgery extensive lymph node dissection,lymph node grouping andnumbering in accordance with the standards developed by the Japan Society ofesophageal disease, lymph nodes after surgery cleaning grouping censorship record ofeach patient lymph node metastasis number. Upper mediastinal lymph nodesincluding105,106TL,106TR,106L,106R,106F,113and114of the lymph nodes in themediastinal lymph nodes, including the lymph nodes107,108,109and112, under themediastinal lymph nodes110and111lymph nodes. Sweep to the lymph nodes isobviously high signal on DWI image can, and the measurement of ADC values andADC values were measured by the lesion site, was identified as suspected metastasislymph nodes.SPSS17.0software for data processing. Measurement data to indicate that thediagnostic performance ADC to lymph nodes using “t” test, DWI diagnosis canesophageal mediastinal lymph node metastasis and lymph node metastasis, which wasconfirmed by pathology after surgery compared and tested by paired t test way, P <0.05for the difference was statistically significant. Using ROC curve to determine theADC values the differential diagnosis of esophageal cancer lymph node metastasisthreshold, the calculation of the corresponding degree of sensitivity, specific, negativepredictive value, positive predictive value and accuracy.Results1.Clinical data and pathological findings:28cases were male and17females; aged50to75years, with a median age of62.5years old. Sub-standard, middlethoracic18cases,27cases of the lower thoracic International esophageal AJCC-UICCTNM staging system （2009）. The group of45patients,13patients had lymph nodemetastasis, metastasis rate was28.9%; total lymphadenectomy585,the average perpatient cleaning13,147metastasis, lymph node metastasis25.1%.2.DWI performance of lymph node metastasis of thoracic esophageal cancer: inaccordance with the established DWI diagnosis of lymph node metastasis andpreoperative diagnosis of metastatic lymph nodes176, pathologically confirmedlymph node metastasis147. The preoperative DWI,sensitivity,specificity,accuracy,positive and negative predictive value was89.1%、93.4%、92.3%、74.4%and96%,respectively．DWI was prior to other sequences in the diagnosis of metastaticlymph nodes and reversal image of DWI displayed the metastatic lymph nodes moredirectly．3.DWI manifestations of thoracic esophageal carcinoma metastatic lymph node:In patients undergoing inspection DWI, can fat, muscle, blood vessels, such asstructure has low signal intensity, metastatic lymph nodes and the original site isobviously high signal intensity. Thyroid, vertebral bodies and accessories, ribs formiddle or slightly high signal intensity. Metastatic lymph nodes of ADC values （[1.71+0.12） x10-3mm2/s] below the metastatic lymph nodes [（2.61+0.15） x10-3mm2/s], the difference was statistically difference （t=7.26, P <0.05）.Conclusion1.The preoperative DWI,sensitivity,specificity,accuracy,positive and negativepredictive value was89.1%、93.4%、92.3%、74.4%and96%,respectively．DWI hasimportant value in the diagnosis of Esophageal mediastinal lymph node metastasis;2.Esophageal cancer metastatic lymph nodes of ADC values significantly lowerthan that of non metastatic lymph nodes.