Metastases in Mediastinal and Hilar Lymph Nodes in Patients With Non-Small Cell Lung Cancer : Quantitative Assessment With Diffusion-Weighted Magnetic Resonance Imaging and Apparent Diffusion Coefficient

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Objective: To evaluate DW MR imaging for detection of metastases in lymph nodes by using quantitative analysis. Methods: Seventy patients with NSCLC were examined with DW and STIR TSE MR imaging. ADC of each lung cancer and lymph node was calculated from DW MR images. Difference of the ADC in a lung cancer and a lymph node was calculated (D1). From STIR TSE MR images, ratios of signal intensity in a lymph node to that in a 0.9% saline phantom was calculated (LSR1). For quantitative analysis, the threshold value for a positive test was determined on a per-node basis and tested for ability to enable a correct diagnosis on a per-patient basis. Results of quantitative analyses of DW and STIR MR images were compared on a per-patient basis with McNemar testing. Results: Mean D1 in the lymph node group with metastases was lower than that in the group without metastases (P < .001). When an D1 of 0.24 x 10^[-3] mm2/sec. was used as the positive-test threshold, sensitivity, specificity, and accuracy were 69.2%, 100%, and 94.0%, respectively on a per-patient basis. There was no significant difference (P > .05) between quantitative analyses of DW MR images and STIR MR images. Conclusions: Quantitative analysis of DW MR images enables differentiation of lymph nodes with metastasis from those without.