title: Diffusion-weighted imaging in oral squamous cell carcinoma using 3 Tesla MRI: is there a chance for preoperative discrimination between benign and malignant lymph nodes in daily clinical routine?
abstract: BACKGROUND
  Preoperative staging of cervical lymph nodes is important to determine the extent of neck dissection in patients with oral squamous cell carcinoma (OSCC).
  
  
  OBJECTIVE
  To evaluate whether a preoperative discrimination of benign and malignant cervical lymph nodes with diffusion-weighted imaging (DWI) (3T) is feasible for clinical application.
  
  
  METHODS
  Forty-five patients with histological proven OSCC underwent preoperative 3T-MRI. DWI (b = 0, 500, and 1000 s/mm(2)) was added to the standard magnetic resonance imaging (MRI) protocol. Mean apparent diffusion coefficients (ADCmean) were measured for lymph nodes with 3 mm or more in short axis by two independent readers. Finally, these results were matched with histology.
  
  
  RESULTS
  Mean ADC was significantly higher for malignant than for benign nodes (1.143 ± 0.188 * 10(-3) mm(2)/s vs. 0.987 ± 0.215 * 10(-3) mm(2)/s). Using an ADC value of 0.994 * 10(-3) mm(2)/s as threshold results in a sensitivity of 80%, specificity of 65%, positive predictive value of 31%, and negative predictive value of 93%.
  
  
  CONCLUSIONS
  Due to a limited sensitivity and specificity DWI alone is not suitable to reliably discriminate benign from malignant cervical lymph nodes in daily clinical routine. Hence, the preoperative determination of the extent of neck dissection on the basis of ADC measurements is not meaningful.
authors.affiliation: Department of Radiology, University Hospital Regensburg, Regensburg, Germany christina.wendl@ukr.de.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Wendl
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Müller
authors.affiliation: Institute of Theroretical Physics, University Regensburg, Regensburg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Eiglsperger
authors.affiliation: Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Fellner
authors.affiliation: Department of Radiology, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Ernst M
authors.initials: EM
authors.lastname: Jung
authors.affiliation: Department of Oral and Maxillofacial Surgery, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Johannes K
authors.initials: JK
authors.lastname: Meier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology*; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D009367:Neoplasm Staging; D012680:Sensitivity and Specificity
keywords: Oral squamous cell carcinoma; apparent diffusion coefficient; diffusion-weighted imaging (DWI); lymph nodes; magnetic resonance imaging (MRI)