Diffusion-weighted magnetic resonance imaging for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis

Santos, Francisco de Souza; Verma, Nupur; Watte, Guilherme; Marchiori, Edson; Mohammed, Tan-Lucien H.; Medeiros, Tássia Machado; Hochhegger, Bruno

doi:10.1590/0100-3984.2020.0084

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Original Article • Radiol Bras 54 (4) • Jul-Aug 2021 • https://doi.org/10.1590/0100-3984.2020.0084 copy

Diffusion-weighted magnetic resonance imaging for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis

Ressonância magnética ponderada em difusão para a diferenciação entre linfonodos torácicos malignos de benignos: uma meta-análise

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes.

Materials and Methods:

This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated.

Results:

We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71-98%) and 93% (95% CI: 79-98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0-43.8) and 0.09 (95% CI: 0.02-0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18-1,243), and the AUC was 0.97 (95% CI: 0.95-0.98).

Conclusion:

DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.

Keywords:
Diffusion magnetic resonance imaging; Lymphadenopathy; Lymph nodes/diagnostic imaging; Thoracic neoplasms/diagnosis; Magnetic resonance imaging; Meta-analysis

Reference	Country	Study design	Number of patients	Total number of MLNs (benign MLNs)	Field strength	b-value (s/mm²)	Result
Reference	Country	Study design	Number of patients	Total number of MLNs (benign MLNs)	Field strength	b-value (s/mm²)	TP	FP	FN	TN
Kosucu et al.⁽²⁰20 Kosucu P, Tekinbas C, Erol M, et al. Mediastinal lymph nodes: assessment with diffusion-weighted MR imaging. J Magn Reson Imaging. 2009;30:292-7.⁾	Turkey	Prospective	35	91 (72)	1.5 T	50; 400	19	0	0	72
Razek et al.⁽²²22 Razek AAKA, Elkammary S, Elmorsy AS, et al. Characterization of mediastinal lymphadenopathy with diffusion-weighted imaging. Magn Reson Imaging. 2011;29:167-72.⁾	Egypt	Prospective	35	35 (7)	1.5 T	0; 300; 600	27	2	1	5
Razek et al.⁽²¹21 Razek AAKA, Gaballa G, Elashry R, et al. Diffusion-weighted MR imaging of mediastinal lymphadenopathy in children. Jpn J Radiol. 2015;33:449-54.⁾	Egypt	Retrospective	32	29 (9)	1.5 T	0; 300; 600	20	2	0	7
Usuda et al.⁽²³23 Usuda K, Maeda S, Motono N, et al. Diagnostic performance of diffusion-weighted imaging for multiple hilar and mediastinal lymph nodes with FDG accumulation. Asian Pac J Cancer Prev. 2015;16:6401-6.⁾	Japan	Prospective	23	23 (16)	1.5 T	0; 800	5	0	2	16
Qi et al.⁽²⁴24 Qi LP, Yan WP, Chen KN, et al. Discrimination of malignant versus benign mediastinal lymph nodes using diffusion MRI with an IVIM model. Eur Radiol. 2018;28:1301-9.⁾	China	Prospective	35	91 (49)	1.5 T	0; 50; 100; 200; 400; 600; 800; 1,000	32	5	10	44
Sigovan et al.⁽²⁵25 Sigovan M, Akl P, Mesmann C, et al. Benign and malignant enlarged chest nodes staging by diffusion-weighted MRI: an alternative to mediastinoscopy? Br J Radiol. 2018;91:20160919.⁾	France	Prospective	54	87 (65)	3.0 T	0; 400; 800	15	10	7	55

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[1] Correspondence: Dr. Francisco de Souza Santos. Brain Institute of Rio Grande do Sul (BraIns). Avenida Ipiranga, 6690, Petrópolis. Porto Alegre, RS, Brazil, 90610-000. Email: franciscodesouzasantos@gmail.com.