Title: The Potential Role of Apparent Diffusion Coefficient Values in the Differentiation of Tuberculous and Malignant Lymph Nodes of Neck - In Correlation with Histopathology
Authors: Dr Rujuta Narendra Rege MD, Dr Praveen Sharma MD, Dr Avinash Naikwadi DNB, Dr Adipudi Renuka MD, Prof. Dr Kulasekaran DMRD MD, Dr C.R. Seena MD DNB
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.21
Abstract
Study was done in 46 patients to ascertain the different causes of cervical lymphadenopathy. 16 patients with cervical lymph node metastasis from head and neck squamous cell carcinomas (SCC), 2 patients with lymphoma, 1 patient with infective etiology and 27 patients with tuberculous lymphadenitis underwent conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI). The ADC values of necrotic and solid portions of lymph nodes were measured and compared. Receiver operating characteristic (ROC) analysis was employed to investigate whether ADC values could help to distinguish between the causes of cervical lymphadenopathy.
Aims: To assess the role of MRI with the help of DWI and ADC to differentiate tuberculous from malignant lymph nodes.
Objective: To calculate sensitivity, specificity and other statistical parameters in the differentiation of tuberculous and malignant lymph nodes of neck using diffusion weighted imaging (DWI) and apparent diffusion coefficient (ADC) values with histopathological examination as the gold standard.
Methods and Material
Inclusion Criteria:
1. Patients presenting with cervical lymphadenopathy detected either clinically or by other radiological investigations. In case of multiple lymph nodes, largest will be included in the study.
2. Patients who undergo biopsy for the same.
Exclusion Criteria
1. Patients with cervical lymph node of size less than 15mm in short axis on USG
2. Painful lymph nodes.
3. Patients with contraindications for MR examination.
4. Patients not willing to participate in the study
Results: In our study we found that the range of ADC values for tuberculous cervical lymph nodes was between 0.99-1.01×10-3mm2/s in the solid portion of the lymph node and 1.27 – 1.31×10-3mm2/s in the necrotic portion of the lymph node. The mean of ADC values for malignant (metastatic) cervical lymph nodes was between 0.78 – 0.87×10-3mm2/s in the solid portion and in the necrotic portion the values were ranging from 1.94 – 2.0 ×10-3mm2/s. The sensitivity was 98.5% and the specificity was 98.3% and the accuracy was 98%. The „p‟ value was <0.001, this showed that there is good agreement between the ADC values and the histopathology results.
Conclusions: The ADC values both of the necrotic and solid portions of the lymph nodes are useful in differentiation between the causes of cervical lymphadenopathy. The ADC value of necrosis is especially helpful in discriminating metastasis from tuberculosis.
Keywords: DWI, ADC value, solid and necrotic portion of lymph nodes.
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