Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases

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Abstract

Introduction: Diffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15% of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer. Methods: All consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADCratio (ADCLN/ADCCLM) were computed by two radiologists for all the LNs. Results: Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADCratio in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10−3 mm2/s, p < 0.001; ADCratio = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10-3 mm2/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADCratio was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators’ agreements were observed. Conclusion: In patients with CLM, ADC values < 1.48 x 10-3 mm2/s can be postulated as a cut-off to distinguish metastatic LNs.

Original languageEnglish
JournalEuropean Journal of Surgical Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Neoplasm Metastasis
Liver
Lymph Nodes
Diffusion Magnetic Resonance Imaging
Area Under Curve
Sensitivity and Specificity
Colorectal Surgery
Rectal Neoplasms
Colorectal Neoplasms
Retrospective Studies
Therapeutics

Keywords

  • ADC measurement
  • Colorectal liver metastases
  • Diffusion-weighted MRI
  • Lymph node metastases
  • N staging
  • Staging of colorectal tumors

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

@article{5a18c4aa4c8b4cdabea446c5bbb8fd16,
title = "Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases",
abstract = "Introduction: Diffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15{\%} of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer. Methods: All consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADCratio (ADCLN/ADCCLM) were computed by two radiologists for all the LNs. Results: Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADCratio in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10−3 mm2/s, p < 0.001; ADCratio = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10-3 mm2/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79{\%}/93{\%}/86{\%} in per LN-analysis and 94{\%}/86{\%}/91{\%} in per-patient analysis). The optimal cut-off for ADCratio was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69{\%}/93{\%}/81{\%} and 76{\%},93{\%}/84{\%}). Excellent inter- and intra-operators’ agreements were observed. Conclusion: In patients with CLM, ADC values < 1.48 x 10-3 mm2/s can be postulated as a cut-off to distinguish metastatic LNs.",
keywords = "ADC measurement, Colorectal liver metastases, Diffusion-weighted MRI, Lymph node metastases, N staging, Staging of colorectal tumors",
author = "Bonifacio Cristiana and Vigan{\`o} Luca and Felisaz Paolo and Lopci Egesta and Cimino Matteo and Poretti Dario and Donadon Matteo and Pedicini Vittorio and Procopio Fabio and Chiti Arturo and Balzarini Luca and Torzilli Guido",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ejso.2018.11.018",
language = "English",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Diffusion-weighted imaging and loco-regional N staging of patients with colorectal liver metastases

AU - Cristiana, Bonifacio

AU - Luca, Viganò

AU - Paolo, Felisaz

AU - Egesta, Lopci

AU - Matteo, Cimino

AU - Dario, Poretti

AU - Matteo, Donadon

AU - Vittorio, Pedicini

AU - Fabio, Procopio

AU - Arturo, Chiti

AU - Luca, Balzarini

AU - Guido, Torzilli

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: Diffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15% of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer. Methods: All consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADCratio (ADCLN/ADCCLM) were computed by two radiologists for all the LNs. Results: Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADCratio in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10−3 mm2/s, p < 0.001; ADCratio = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10-3 mm2/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADCratio was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators’ agreements were observed. Conclusion: In patients with CLM, ADC values < 1.48 x 10-3 mm2/s can be postulated as a cut-off to distinguish metastatic LNs.

AB - Introduction: Diffusion-weighted MRI (DWI) contributes to N staging of rectal cancers and diagnosis of colorectal liver metastases (CLM). About 15% of CLM patients have loco-regional lymph node (LN) metastases that impact prognosis and treatment strategy. This retrospective study is the first one to evaluate quantitative ADC measurement as a tool to identify metastatic LNs in patients with liver metastases from colorectal cancer. Methods: All consecutive patients undergoing surgery for CLM between 2008 and 2015 were considered. Inclusion criteria were: intraoperative retrieval of at least one LN; LN ≥ 5 mm; DWI performed ≤2 months before surgery. The ADC and ADCratio (ADCLN/ADCCLM) were computed by two radiologists for all the LNs. Results: Among 555 patients operated for CLM, 32 met the inclusion criteria. Fifty-six LNs were analyzed and 28 were metastatic. ADC and ADCratio in metastatic LNs were lower than in benign LNs (ADC = 1.37 vs. 1.83 × 10−3 mm2/s, p < 0.001; ADCratio = 1.26 vs. 1.73, p < 0.001). The optimal cut-off value for ADC was 1.48 x 10-3 mm2/s (AUC = 0.85, p < 0.001, sensitivity/specificity/accuracy 79%/93%/86% in per LN-analysis and 94%/86%/91% in per-patient analysis). The optimal cut-off for ADCratio was 1.15 (AUC = 0.80, p < 0.001, sensitivity/specificity/accuracy 69%/93%/81% and 76%,93%/84%). Excellent inter- and intra-operators’ agreements were observed. Conclusion: In patients with CLM, ADC values < 1.48 x 10-3 mm2/s can be postulated as a cut-off to distinguish metastatic LNs.

KW - ADC measurement

KW - Colorectal liver metastases

KW - Diffusion-weighted MRI

KW - Lymph node metastases

KW - N staging

KW - Staging of colorectal tumors

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U2 - 10.1016/j.ejso.2018.11.018

DO - 10.1016/j.ejso.2018.11.018

M3 - Article

AN - SCOPUS:85057619569

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

ER -