Ahmed Abdel Razek, Presenter: Nothing to Disclose

To assess the clinical usefulness of diffusion weighted MR imaging and dynamic susceptibility contrast enhanced perfusion weighted MR imaging in patient with cervical lymphadenopathy.

This study included 42 consecutive patients (27M, 15F aged 13-72 ys: mean 45ys) with cervical lymphadenopathy. Diffusion weighted MR images were acquired with a b-factor of 0,500 & 1000 sec/mm2. Apparent diffusion coefficient (ADC) map was reconstructed and ADC value of the lymph node was calculated. Dynamic contrast enhanced MR was performed after bolus injection of Gadolinium-DTPA (0.3ml mol/ kg BW) every 2 seconds for 2 minutes. Signal intensity versus time curve of the tumor was created and maximum signal intensity loss of the tumor was calculated. Histopathological examination revealed malignant (49 metastasis, 21 lymphoma) and benign (11 reactive, 4 granulomatous) nodes. Statistical analysis was done in the form of receiver operating curve with calculation of sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV).

The mean ADC value of malignant lymph nodes (1.09±0.13X10-3mm2/sec) was significantly lower than those of benign lymph nodes (1.57±0.11 X10-3mm2/sec).The mean percentage of maximum signal intensity loss of malignant nodes was 47.3±8.2% and of benign nodes was 18.7±3.9%. There was statistically difference for ADC value (P<0.02) and for maximum percentage of signal intensity loss (p<0.004) between benign and malignant nodes. The threshold value of 1.31 X 10-3 mm2/sec for ADC value was used to differentiate malignant from benign nodes provided accuracy of 95%, sensitivity 92%, specificity 100%, PPV 89% and NPV 84%. Selection of 29.5% as a threshold parameter for maximum signal intensity loss has 98% accuracy, 94% sensitivity, 89% specificity, 99% PPV and 88% NPV.

We concluded that diffusion weighted MR imaging and dynamic susceptibility contrast enhanced perfusion weighted MR imaging are non-invasive promising methods that used for assessment of cervical lymph nodes.

Diffusion weighted and dynamic susceptibility contrast enhanced perfusion weighted MR imaging are recommended for differentiating benign from malignant cervical lymph nodes.

Abdel Razek, A, Role of Diffusion-weighted MR and Dynamic Susceptibility Contrast-enhanced Perfusion-weighted MR Imaging in Cervical Lymphadenopathy.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6005267.html