Diffusion-Weighted Imaging (DWI) derived from PET/MRI for lymph node assessment in patients with Head and Neck Squamous Cell Carcinoma (HNSCC)

Omar Freihat, Tamas Pinter, András Kedves, Dávid Sipos, Zsolt Cselik, Imre Repa, Árpád Kovács, Omar Freihat, Tamas Pinter, András Kedves, Dávid Sipos, Zsolt Cselik, Imre Repa, Árpád Kovács

Abstract

Background: To determine the usefulness of Diffusion Weighted Imaging (DWI) derived from PET/MRI in discriminating normal from metastatic lymph nodes and the correlation between the metastatic lymph nodes with the grade and the localization of the primary tumor.

Methods: Retrospective study of 90 lymph nodes from 90 subjects; 65 patients who had proven histopathological metastatic lymph nodes from (HNSCC) who had undergone 18F- PET/MRI for clinical staging and assessment and twenty-five lymph nodes were chosen from 25 healthy subjects. Apparent Diffusion Coefficient (ADC) map was generated from DWI with b values (0 and 800 s/mm2). ADC values of the metastatic lymph nodes were calculated and compared to the normal lymph nodes ADC values, ROC was used to determine the best cut-off values to differentiate between the two group. Metastatic lymph nodes ADC mean values were compared to primary tumor grade and localization.

Results: ADCmean value of the metastatic lymph nodes in the overall sample (0.899 ± 0.98*10- 3 mm2/sec) was significantly lower than the normal lymph nodes' ADCmean value (1.267 ± 0.88*10- 3 mm2/sec); (P = 0.001). The area under the curve (AUC) was 98.3%, sensitivity and specificity were 92.3 and 98.6%, respectively, when using a threshold value of (1.138 ± 0.75*10- 3 mm2/sec) to differentiate between both groups. Significant difference was found between metastatic lymph nodes (short-axis diameter < 10 mm), ADCmean (0.898 ± 0.72*10- 3 mm2/sec), and the benign lymph nodes ADCmean, (P = 0.001). No significant difference was found between ADCmean of the metastatic lymph nodes < 10 mm and the metastatic lymph nodes > 10 mm, ADCmean (0.899 ± 0.89*10- 3 mm2/sec), (P = 0.967). No significant differences were found between metastatic lymph nodes ADCmean values and different primary tumor grades or different primary tumor localization, (P > 0.05).

Conclusion: DWI-ADC is an effective and efficient imaging technique in differentiating between normal and malignant lymph nodes, and might be helpful to discriminate sub-centimeters lymph nodes.

Trial registration: The trial is registered in clinical trials under ID: NCT04360993 , registration date: 17/04/2020.

Keywords: ADC; Benign; DWI; HNSCC; Lymph nodes; MRI; Metastasis.

Conflict of interest statement

All authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
flowchart of the included subjects and the criteria used
Fig. 2
Fig. 2
65 years old male with para-pharyngeal sub-centimeters lymph node positive malignancy from laryngeal SCC on the left side of the neck. a T2 coronal show the lymph node, (arrow). (B) T2 axial show the axial extension of the lymph node (6x8mm), (arrow) (c) DWI show hyperintense area at b value 800mm2/s (arrow) and (d) ADC map on the targeted lymph node show hypointense signal, an ADC value of (0.841 ± 0.19*10− 3 mm2/s)
Fig. 3
Fig. 3
71 years old male with left positive para-pharyngeal enlarged lymph node from oropharyngeal SCC on the left side of the neck. a T2 coronal show enlarged lymph node axial dimensions, (34x35mm) (arrow). b T2 axial show the axial extension of the lymph node. c DWI show high signal at b value 800mm2/s and (d) the ADC map on the targeted lymph node show an ADC value of (0.851 ± 0.16*10− 3 mm2/s)
Fig. 4
Fig. 4
61 years old healthy male with normal lymph node in the left side of the neck. a T2 coronal show normal lymph nodes (arrow). b T2 axial view shows the axial extension of the left lymph node, (5x7mm), (arrow). c DWI show high signal at b value 800mm2/s (arrow) and (d) the ADC map on the targeted lymph node show an ADC value of (1.467 ± 0.15*10− 3 mm2/s) (arrow)
Fig. 5
Fig. 5
a Box-and-whisker plots of the normal and metastatic lymph nodes ADC values; significant difference was reported. P < 0.05. b ROC curve for the ADC value for differentiating between metastatic and normal
Fig. 6
Fig. 6
Box-and-whisker plots of the mean ADC values of the metastatic lymph nodes sub-grouped into (short-axis diameter  10 mm) were significantly lower than normal lymph nodes ADC values (P = 0.001), no significant difference between metastatic lymph nodes with short-axis diameter < 10 mm and metastatic lymph nodes with short-axis diameter > 10 mm, (P = 0.967)
Fig. 7
Fig. 7
a Box-and-whisker plots of the lymph nodes ADC according to the primary tumor grades (G1-G3). No significant difference was found between the three grades, P > 0.05
Fig. 8
Fig. 8
Box-and-whisker plots of the lymph nodes ADC according to the primary tumor localization. No significant differences were reported, P > 0.05

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