| Objective: To evaluate the accuracy of diffusion-weighted imaging（DWI）in diagnosing metastatic lymph nodes and to provide theoretic basefor clinical practices by detecting metastatic lymph nodes with ComputedTomography (CT) and DWI compared with the postoperative pathologicalgolden criteria in esophageal carcinoma and lung cancer.Methods: Forty-three patients were selected in this study from October2012to May2013, including35cases of esophageal carcinoma,8cases oflung cancer. Each patient was examined by CT and DWI scan using the sameposition. All the CT and DWI images were transmitted to the treatmentplanning system（Pinnacle8.0）by local area network. The image fusion methodbased on manual operation. Manually outlining all visible lymph nodes ofhigh-risk area showed in the CT images, including the lymph nodes whoseshort diameter less than1.0cm. Measuring the long diameter, short diameterand volume of the lymph nodes. Compared with postoperative pathologicalgolden criteria, lymph nodes was observed and analyzed on CT and DWIimaging. The sensitivity, specificity, positive and negative predictive valuesand accuracy in diagnosis of metastasis of lymph node of CT and DWI werecalculated and compared. To evaluate the value of DWI in assessment ofregional lymph nodes status. Statistical analysis was performed using an SPSSstatistical package (Version13.0).Results:（1）In the entire group, the pathological examination confirmedmetastasis in34out of569lymph nodes. The lymph node metastasis rate andlymph node metastasis degree were34.88%and5.98%, respectively.（2）Based on the CT images,60pieces of lymph node were defined, includingpathological positive lymph node17pieces. The sensitivity, specificity,positive and accuracy of detection of lymph nodes metastasis were 62.96%,18.87%,33.75%on CT（.3）According to the DWI images,28piecesof lymph node were defined, including pathological positive lymph node17pieces. The sensitivity, specificity, positive and accuracy of detection of lymphnodes metastasis were56.67%,79.24%,71.08%on DWI.(4)Based on thefusion image of CT and MRI,26pieces of lymph node were defined,including pathological positive lymph node16pieces. The sensitivity,specificity, positive and accuracy of detection of lymph nodes metastasis were53.33%,81.13%,71.08%.(5)To reject23pieces of lymph node up theaortopulmonary window level, because they have no pathological results. Thesensitivity, specificity and accuracy of detection of lymph nodes metastasiswere62.96%,33.33%,47.37%,56.67%,80%,68.33%and53.33%,83.33%,68.33%on CT, DWI and CT-DWI, respectively.(6)The specificity and accuracy ofdetection of lymph nodes metastasis on CT-DWI were significant higher thanthat of CT（χ2=15.429,P=0.000;χ2=5.278，P=0.022),while the sensitivitywas similar（χ2=0.541,P=0.462）. The sensitivity, specificity and accuracy ofdetection of lymph nodes metastasis were similar on CT and CT-DWI.（7）Lymph nodes with short diameter≥1.20cm as a diagnosis of metastaticlymph nodes of the boundary value, the sensitivity, specificity and accuracy ofwere44.44%,100%and73.21%, respectively.Conclusion: Based on the CT images only，The accuracy of detection oflymph nodes metastasis was low. CT had high specificity and accuracy in thedetection of the lymph nodes with the short diameter beyond1.2cm, but hadlow sensitivity. DWI was more conformed to the pathology results than CT,and it can be applied to diagnosing metastatic lymph nodes. The specificityand accuracy of detection of lymph nodes metastasis on CT-DWI weresignificant higher than that of CT, while the sensitivity was similar. CT-DWIcan be used to improve the diagnosis level of regional lymph node. |
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