DWI Combined with 3D-VIBE in Evaluating Metastatic Lymph Nodes Secondary to Hilar Cholangiocarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Dongsheng ¹ , WANG Xiaodong ¹ , CHEN Weixia ¹ , PENG Jin ¹ , SU Wei ² , ZHANG Hongjing ¹

1.Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.Department of Pathology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Magnetic resonance imaging; Diffusion weighted imaging; Three-dimensional volumetric interpolated breath-hold examination; Hilarcholangiocarcinoma; Lymph node metastasis

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ObjectiveTo investigate the value of diffusion weighted imaging (DWI) combined with three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma. MethodsFrom July 2009 to March 2011, DWI examination was performed in 37 patients with hilar cholangiocarcinoma, which was compared with 3D-VIBE sequences. The morphological characteristics and distribution were analyzed for metastatic and nonmetastatic lymph nodes. Signal intensity (SI) was measured on DWI images and apparent diffusion coefficient (ADC) was calculated for each lymph node. The SI of lymph nodes (SILN） and liver (SIliver) were also measured and the ratio of SI was calculated. The ADC and the ratio of SI were compared between metastatic and nonmetastatic lymph nodes. ResultsThere were fifty-nine groups of lymph nodes in 37 patients with hilar cholangiocarcinoma, fifty-one groups were revealed in both DWI and 3D-VIBE sequences, and eight groups were only demonstrated in one sequence (P=0.070). The short diameters were (1.05±0.42) cm and (0.78±0.22) cm on 3D-VIBE images for metastatic and nonmetastatic lymph nodes, respectively (P=0.030). The ADC value in metastatic lymph nodes was (1.64±0.3)×10-3 mm2/s, which was significantly lower than that in nonmetastatic lymph nodes 〔(2.28±0.79)×10-3 mm2/s〕 on DWI images (P=0.033). There were no significant differences in SILN/SIliver between metastatic and nonmetastatic lymph nodes on images of portal venous phase and 3 min delayed contrast-enhanced phase. ConclusionsDifferences of ADC and short diameter can provide valuable information to differentiate metastatic lymph nodes with nonmetastatic lymph nodes. When combined with 3D-VIBE sequence, DWI is more effective in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.

Citation： WU Dongsheng ,WANG Xiaodong,CHEN Weixia,PENG Jin,SU Wei,ZHANG Hongjing. DWI Combined with 3D-VIBE in Evaluating Metastatic Lymph Nodes Secondary to Hilar Cholangiocarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(7): 773-778. doi: Copy

1.	Miyazaki M, Ito H, Nakagawa K, et al. Parenchymapreserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma [J]. J Am Coll Surg, 1999, 189(6): 575583.
2.	Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3): 385392.
3.	孙学军，石景森，何平．影响胆管癌切除术后的预后因素分析 [J]．中国普外基础与临床杂志，2006， 13（1）： 8588．.
4.	黄志强．肝门部胆管癌的外科治疗与发展 [J]．中国普外基础与临床杂志， 2003， 10（5）： 425428．.
5.	李洁，张晓鹏，曹崑，等．乳腺 MR动态增强扫描联合扩散加权成像的临床应用评价 [J]．中国医学影像技术， 2005， 21（12）： 18211825．.
6.	张晓鹏，曹崑，唐磊．子宫内膜癌和正常子宫扩散加权成像信号强度与 ADC值关系的研究 [J]．中国医学影像技术， 2005， 21（12）： 18441847．.
7.	Starlack JM, Adalsteinsson E, Adam MF, et al. In vivo 1H MR spectroscopy of human head and neck lymph node metastasis and comparison with oxygen tension measurements [J]. AJNR Am J Neuroradiol, 2000, 21(1): 183193.
8.	梁颖，罗德红，吴宁，等．颈部恶性淋巴结的多层螺旋 CT 灌注研究 [J]．中华放射学杂志， 2004， 38（11）： 11931197．.
9.	Fischbein NJ, Noworolski SM, Henry RG, et al. Assessment of metastatic cervical adenopathy using dynamic contrastenhanced MR imaging [J]. AJNR Am J Neuroradiol, 2003, 24(3): 301311.
10.	丛冠宁，秦明伟，贺丹，等．高分辨MRI对直肠癌TNM分期及环周切缘的评估 [J]．中国普外基础与临床杂志， 2010， 17（9）： 894900．.
11.	Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
12.	Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer:application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [J]. Ann Surg, 2003, 238(1): 8492.
13.	Bismuth H, Majno PE. Hepatobiliary surgery [J]. J Hepatol, 2000, 32(1 Suppl): 208224.
14.	黄志强．肝门部胆管癌外科治疗的现状与展望 [J]．中国普外基础与临床杂志， 2005， 12（4）： 317320．.
15.	Lee HY, Kim SH, Lee JM, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma:combined CT and cholangiography with revised criteria[J]. Radiology, 2006, 239(1): 113121.
16.	Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging [J]. J Nucl Med, 2004, 45(9): 15091518.
17.	Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis [J]. AJR Am J Roentgenol, 1992, 158(5): 961969.
18.	Yousem DM, Som PM, Hackney DB, et al. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT [J]. Radiology, 1992, 182(3): 753759.
19.	Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
20.	Kim JK, Kim KA, Park BW, et al. Feasibility of diffusionweighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience [J]. J Magn Reson Imaging, 2008, 28(3): 714719.
21.	Nasu K, Kuroki Y, Nawano S, et al. Hepatic metastases:diffusionweighted sensitivityencoding versus SPIOenhanced MR imaging[J]. Radiology, 2006, 239(1): 122130.
22.	Vandecaveye V, De KF, Nuyts S, et al. Detecting nodal metastases in primary head and neck cancer with diffusionweighted MRI: initial experience [J]. Cancer Imaging, 2006, 6(Spec No A): S96S101.
23.	张赟，梁碧玲，高立，等．颈部淋巴结的 MR扩散加权成像 [J]．临床放射学杂志， 2007， 26（3）： 244247．.
24.	Ichikawa T, Haradome H, Hachiya J, et al. Diffusionweighted MR imaging with singleshot echoplanar imaging in the upper abdomen: preliminary clinical experience in 61 patients [J]. Abdom Imaging, 1999, 24(5): 456461.
25.	Yin LL, Song B, Xu J, et al. Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breathhold examination magnetic resonance imaging sequence [J]. Chin Med J (Engl), 2007, 120(8): 636642.
26.	Engels JT, Balfe DM, Lee JK. Biliary carcinoma: CT evaluation of extrahepatic spread [J]. Radiology, 1989, 172(1): 3540.
27.	Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning [J]. Abdom Imaging, 2008, 33(4): 444451.

1. Miyazaki M, Ito H, Nakagawa K, et al. Parenchymapreserving hepatectomy in the surgical treatment of hilar cholangiocarcinoma [J]. J Am Coll Surg, 1999, 189(6): 575583.
2. Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma:audit of 110 patients who under went regional and paraaortic node dissection[J]. Ann Surg, 2001, 233(3): 385392.
3. 孙学军，石景森，何平．影响胆管癌切除术后的预后因素分析 [J]．中国普外基础与临床杂志，2006， 13（1）： 8588．.
4. 黄志强．肝门部胆管癌的外科治疗与发展 [J]．中国普外基础与临床杂志， 2003， 10（5）： 425428．.
5. 李洁，张晓鹏，曹崑，等．乳腺 MR动态增强扫描联合扩散加权成像的临床应用评价 [J]．中国医学影像技术， 2005， 21（12）： 18211825．.
6. 张晓鹏，曹崑，唐磊．子宫内膜癌和正常子宫扩散加权成像信号强度与 ADC值关系的研究 [J]．中国医学影像技术， 2005， 21（12）： 18441847．.
7. Starlack JM, Adalsteinsson E, Adam MF, et al. In vivo 1H MR spectroscopy of human head and neck lymph node metastasis and comparison with oxygen tension measurements [J]. AJNR Am J Neuroradiol, 2000, 21(1): 183193.
8. 梁颖，罗德红，吴宁，等．颈部恶性淋巴结的多层螺旋 CT 灌注研究 [J]．中华放射学杂志， 2004， 38（11）： 11931197．.
9. Fischbein NJ, Noworolski SM, Henry RG, et al. Assessment of metastatic cervical adenopathy using dynamic contrastenhanced MR imaging [J]. AJNR Am J Neuroradiol, 2003, 24(3): 301311.
10. 丛冠宁，秦明伟，贺丹，等．高分辨MRI对直肠癌TNM分期及环周切缘的评估 [J]．中国普外基础与临床杂志， 2010， 17（9）： 894900．.
11. Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
12. Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer:application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization [J]. Ann Surg, 2003, 238(1): 8492.
13. Bismuth H, Majno PE. Hepatobiliary surgery [J]. J Hepatol, 2000, 32(1 Suppl): 208224.
14. 黄志强．肝门部胆管癌外科治疗的现状与展望 [J]．中国普外基础与临床杂志， 2005， 12（4）： 317320．.
15. Lee HY, Kim SH, Lee JM, et al. Preoperative assessment of resectability of hepatic hilar cholangiocarcinoma:combined CT and cholangiography with revised criteria[J]. Radiology, 2006, 239(1): 113121.
16. Torabi M, Aquino SL, Harisinghani MG. Current concepts in lymph node imaging [J]. J Nucl Med, 2004, 45(9): 15091518.
17. Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis [J]. AJR Am J Roentgenol, 1992, 158(5): 961969.
18. Yousem DM, Som PM, Hackney DB, et al. Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT [J]. Radiology, 1992, 182(3): 753759.
19. Holzapfel K, Duetsch S, Fauser C, et al. Value of diffusionweighted MR imaging in the differentiation between benign and malignant cervical lymph nodes [J]. Eur J Radiol, 2009, 72(3): 381387.
20. Kim JK, Kim KA, Park BW, et al. Feasibility of diffusionweighted imaging in the differentiation of metastatic from nonmetastatic lymph nodes:early experience [J]. J Magn Reson Imaging, 2008, 28(3): 714719.
21. Nasu K, Kuroki Y, Nawano S, et al. Hepatic metastases:diffusionweighted sensitivityencoding versus SPIOenhanced MR imaging[J]. Radiology, 2006, 239(1): 122130.
22. Vandecaveye V, De KF, Nuyts S, et al. Detecting nodal metastases in primary head and neck cancer with diffusionweighted MRI: initial experience [J]. Cancer Imaging, 2006, 6(Spec No A): S96S101.
23. 张赟，梁碧玲，高立，等．颈部淋巴结的 MR扩散加权成像 [J]．临床放射学杂志， 2007， 26（3）： 244247．.
24. Ichikawa T, Haradome H, Hachiya J, et al. Diffusionweighted MR imaging with singleshot echoplanar imaging in the upper abdomen: preliminary clinical experience in 61 patients [J]. Abdom Imaging, 1999, 24(5): 456461.
25. Yin LL, Song B, Xu J, et al. Hilar cholangiocarcinoma: preoperative evaluation with a three dimensional volumetric interpolated breathhold examination magnetic resonance imaging sequence [J]. Chin Med J (Engl), 2007, 120(8): 636642.
26. Engels JT, Balfe DM, Lee JK. Biliary carcinoma: CT evaluation of extrahepatic spread [J]. Radiology, 1989, 172(1): 3540.
27. Masselli G, Gualdi G. Hilar cholangiocarcinoma: MRI/MRCP in staging and treatment planning [J]. Abdom Imaging, 2008, 33(4): 444451.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

DWI Combined with 3D-VIBE in Evaluating Metastatic Lymph Nodes Secondary to Hilar Cholangiocarcinoma

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