Diffusion-weighted MR imaging in lymphadenopathy for differentiation of malignant lymphoma, metastatic lymph node and benign lymphadenopathy

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1 Diffusion-weighted MR imaging in lymphadenopathy for differentiation of malignant lymphoma, metastatic lymph node and benign lymphadenopathy Poster No.: R-0089 Congress: RANZCR-AOCR 2012 Type: Scientific Exhibit Authors: F. Kotake, S. Yoshida, S. Kikushima, T. Funatsu, M. Hoshina, H. Shindou; JP Keywords: DOI: Lymph nodes, MR-Diffusion/Perfusion, Diagnostic procedure, Lymphoma, Metastases, Inflammation /ranzcraocr2012/R-0089 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply RANZCR's endorsement, sponsorship or recommendation of the third party, information, product or service. RANZCR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold RANZCR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies,.ppt slideshows,.doc documents and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Purpose Diffusion-weighted imaging (DWI) offers the possibility of establishing criteria for lesion characterization independently of T1 and T2 relaxation times, and without the need for contrast agent administration, by quantifying diffusion effects via apparent diffusion coefficient (ADC) measurements. The aim of this study was to evaluate the diagnostic contribution of DWI using ADC values to differentiate malignant lymphoma, metastatic lymph node and benign lymphadenopathy. Methods and Materials Subjects: The subjects consisted of 65 patients (30 women and 35 men; age range, years; mean age, 57.8 ± 16.6 years). A total of 18 patients had histologically confirmed malignant lymphoma, 29 patients had metastatic lymph node and 18 patients had benign lymphadenopathy (Table 1, 2). In each patients, the largest lymph node (27.2 ± 12.6 mm) of 15 mm or greater in short-axis diameter was selected for evaluation. Magnetic resonance imaging: DW images were performed using echo-planar imaging sequences, utilizing a short T1 inversion recovery method for the neck and pelvis, a chemical shift-selective method for the brain, chest and abdomen, and a respiratory-triggered method for the chest and abdomen. The imaging parameters were 3000/70-89/4-8 (TR/TE/excitation) for the chemical shift-selective method and 5600/180/76-78/8 (TR/TI/TE/excitation) for the short T1 inversion recovery method; echo train length, ; slice thickness/interslice gap, 5.0 mm mm/20%, with b-factors set at 50 and sec/mm 2. All DW images were shown in monochrome and reversed. Image analysis: We set the region of interest in the center of the lymph node, except for necrotic areas, and calculated the ADC values. Kruskal Wallis test was used to analyze the differrence in the mean ADC values amang malignant lymphoma, metastatic lymph node and benign lymphadenopathy. P values less than 0.01 were considered to indicate statistically significant differences. All analyses were performed using statistical software (SPSS 16.0 for Windows, SPSS Japan, Tokyo, Japan) Images for this section: Page 2 of 14

3 Table 1 Page 3 of 14

4 Table 2 Page 4 of 14

5 Results #The mean ADC values ( 10-3 mm 2 /sec) of malignant lymphoma, metastatic lymph node and benign lymphadenopathy are summarized in Table 3 and Fig. 1. # The mean ADC value of malignant lymphoma (0.63 ± 0.11) (Figs. 2, 3) was significantly lower than that of metastatic lymph node (0.85 ± 0.12) (Figs. 4, 5) (p < 0.01). # The mean ADC value of metastatic lymph node (0.85 ± 0.12) was significantly lower than that of benign lymphadenopathy (1.03 ± 0.12) (Figs. 6-8) (p < 0.01). Images for this section: Table 3 Page 5 of 14

6 Fig. 1: Scatter plots show the distribution of ADC values of malignant lymphoma, metastatic lymph node and benign lymphadenopathy. The mean ADC value of malignant lymphoma (0.63 ± 0.11) was significantly lower than that of metastatic lymph node (0.85 ± 0.12) (p < 0.01). The mean ADC value of metastatic lymph node was significantly lower than that of benign lymphadenopathy (1.03 ± 0.12) (p < 0.01) Page 6 of 14

7 Fig. 2: (a, b) T1- and T2-weighted images demonstrate a 67-mm enlarged right internal jugular node with homogeneous signal intensity (white arrows). (c) Diffusion-weighted image (monochrome reverse image) shows a strong high signal intensity (black arrow). (d) ADC map shows the mass with a very low signal intensity (white arrow) and the ADC value is significantly reduced mm2/sec. Page 7 of 14

8 Fig. 3: (a) T1-weighted image demonstrates a 80-mm enlarged left inguinal node with homogeneous signal intensity (white arrows). (b) Diffusion-weighted image (monochrome reverse image) shows a strong high signal intensity (black arrow).the ADC value is as low as mm2/sec. Page 8 of 14

9 Fig. 4: (a) T1-weighted image shows an enlarged right superior internal jugular node (white arrow). (b) Diffusion-weighted image (monochrome reverse imaging) shows high signal intensity (black arrow). (c) ADC map shows the mass with a low signal intensity (white arrow), and the ADC value is mm2/sec. (d) T1-weighted image after the radiation therapy (total dose, 40GY) shows no change in the size of the lymph node (white arrow). (e, f) The signal intensity of the lymph node decreases in diffusion-weighted image (monochrome reverse imaging) after the radiation therapy (black arrow), and the ADC value increases to mm2/sec. Page 9 of 14

10 Fig. 5: (a, b) T1- and T2-weighted images demonstrate a diffuse enlarged para-aortic nodes with homogeneous signal intensity (white arrows). (c) Diffusion-weighted image (monochrome reverse image) shows high signal intensity (black arrows). (d) ADC map shows the mass with a low signal intensity (white arrows), and the ADC value is mm2/sec. Page 10 of 14

11 Fig. 6: (a, b) T1- and T2-weighted images demonstrate an enlarged right paratracheal node with homogeneous signal intensity (white arrows). (c) Diffusion-weighted MR image (monochrome reverse image) shows high signal intensity (black arrow). (d) ADC map shows the mass with a mildly high signal intensity (white arrows), and the ADC value is mm2/sec. Page 11 of 14

12 Fig. 7: (a, b) T1- and fat-suppressed T2-weighted images demonstrate an enlarged left superior internal jugular node with heterogeneous signal intensity (white arrows). (c) Fatsuppressed Gd-DTPA-enhanced T1-weighted image shows central low signal intensity and rim enhancement (white arrow). (d) Diffusion-weighted MR image (monochrome reverse image) shows high signal intensity (black arrow). The ADC value is mm2/sec. Page 12 of 14

13 Fig. 8: (a, b) T1- and T2-weighted images demonstrate a-105-mm irregular-walled cavity nodule in the right lower lobe (white arrow) and a marked subcarinal lymphadenopathy (white arrowhead). (c) Diffusion-weighted image (monochrome reverse imaging) demonstrates a high signal intensity in the irregular wall (black arrow) and subcarinal lymphadenopathy (black arrowhead). (d) ADC map shows the irregular wall (white arrow) and subcarinal lymphadenopathy (white arrowhead) with a low signal intensity and the ADC values are mm2/sec and mm2/sec. Page 13 of 14

14 Conclusion Diffusion-weighted MR imaging with quantitative ADC measurements was useful in the differential diagnosis of malignant lymphoma, metastatic lymph node and benign lymphadenopathy. Personal Information Fumio Kotake, MD, PhD Department of Radiology, Tokyo Medical University, Ibaraki Medical Center Ami-machi Chuo Inashikigun Ibaraki Japan References 1. Razek AAKA, et al. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 2006; 16: King AD, et al. Malignant cervical lymphadenopathy: Diagnostic accuracy of diffusionweighted MR imaging. Radiology 2007; 245: Perrone A, et al. Diffusion-weighted MRI in cervical lymph nodes: Differentiation between benign and malignant lesions. Eur J Radiol 2011; 77: Sharma A, et al. Patterns of lymphadenopathy in thoracic malignancies. RadioGraphics 2004; 24: Brennan DD, et al. A comparison of whole-body MRI and CT for the staging of lymphoma. AJR 2005; 185: Page 14 of 14