title: Usefulness of 3T diffusion-weighted MRI for discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma: a pilot study.
abstract: OBJECTIVE
  To study the diagnostic accuracy of 3T diffusion-weighted MRI (DW-MRI) for the discrimination of reactive and metastatic cervical lymph nodes in patients with oral squamous cell carcinoma.
  
  
  METHODS
  DW T1 and T2 weighted MRI was performed in 25 patients with biopsy-proved primary oral squamous cell carcinoma. The mean apparent diffusion coefficient (ADC) values of 30 histopathologically proved reactive lymph nodes and 21 histopathologically proved metastatic lymph nodes were compared using an unpaired t-test. A cut-off ADC value with optimal diagnostic sensitivity, specificity and area under the curve in discrimination of the two groups was determined using a receiver operating characteristic curve analysis.
  
  
  RESULTS
  The mean ADC values of reactive lymph node and metastatic lymph node groups were (1.037 ± 0.149) × 10(-3) and (0.702 ± 0.197) × 10(-3) mm(2) s(-1), respectively. A statistically significant difference in ADC values of the two groups was certified (p < 0.0001). An optimal ADC threshold value of 0.887 × 10(-3) mm(2) s(-1) was suggested as the cut-off point, which resulted in 93.33% sensitivity, 80.95% specificity, 88.20% accuracy and area under curve of 0.887.
  
  
  CONCLUSIONS
  Our preliminary study indicates that the addition of 3T DW-MRI may be useful for discriminating between reactive lymph nodes and metastatic lymph nodes in patients with oral squamous cell carcinoma. However, larger studies are still required to validate our results and to standardize this imaging technique for daily clinical practice.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: J
authors.initials: J
authors.lastname: Si
authors.forename: S
authors.initials: S
authors.lastname: Huang
authors.forename: H
authors.initials: H
authors.lastname: Shi
authors.forename: Z
authors.initials: Z
authors.lastname: Liu
authors.forename: Q
authors.initials: Q
authors.lastname: Hu
authors.forename: G
authors.initials: G
authors.lastname: Wang
authors.forename: G
authors.initials: G
authors.lastname: Shen
authors.forename: D
authors.initials: D
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001706:Biopsy / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods* / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000473:pathology*; D037981:Neck Dissection / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity
keywords: apparent diffusion coefficient; cervical lymph node metastasis; diffusion-weighted magnetic resonance imaging; oral squamous cell carcinoma