title: Detection of Lymph Nodes Metastasis in Biliary Carcinomas: Morphological Criteria by MDCT and the Clinical Impact of DWI-MRI.
abstract: OBJECTIVE
  This study was conducted to assess the usefulness of multi-slice CT (MDCT) and diffusion weighted MR images (DWI-MRI) for diagnosis of metastatic lymph nodes (LNs) in biliary carcinomas.
  
  
  METHODS
  Eighteen patients with biliary carcinomas (total 121 LNs) underwent surgical resection were included. In MDCT, the following criteria were measured: the maximum diameter, the enhanced value and the long and short axis (L/S) ratio. In DWI-MRI, the apparent diffusion coefficients (ADCs) were measured from ADC maps.
  
  
  RESULTS
  In ROC analysis, the maximum diameter has the highest diagnostic power with area under curves of 0.903. And when the maximum diameter 8 mm and L/S ratio is less than 2, the accuracy was improved with a sensitivity of 81%, positive predictive value (PPV) of 45%. In DWI-MRI, ADCs values of metastatic LNs significantly lower than that of non-metastatic LNs (mean: 1.65 vs. 2.11 x10 3mm2/s). When the ADC value of 1.8 x10(-3) was used as a cut-off value, the best results were obtained with sensitivity of 75%, PPV of 82%.
  
  
  CONCLUSIONS
  Using MDCT, diagnosis of LNs metastasis should be more than 8mm diameter and less than 2 of L/S ratio. In addition, DWI-MRI is more useful modality for diagnosis of LNs metastasis.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Morine
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Shimada
authors.forename: Satoru
authors.initials: S
authors.lastname: Imura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ikemoto
authors.forename: Jun
authors.initials: J
authors.lastname: Hanaoka
authors.forename: Mami
authors.initials: M
authors.lastname: Kanamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Tohru
authors.initials: T
authors.lastname: Utsunomiya
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000601:surgery; D002277:Carcinoma / Q000175:diagnosis* / Q000601:surgery; D015331:Cohort Studies; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009367:Neoplasm Staging; D012372:ROC Curve; D012189:Retrospective Studies