Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2024; 30(4): 308-317
Published online Jan 28, 2024. doi: 10.3748/wjg.v30.i4.308
Value of multiple models of diffusion-weighted imaging to predict hepatic lymph node metastases in colorectal liver metastases patients
Hai-Bin Zhu, Bo Zhao, Xiao-Ting Li, Xiao-Yan Zhang, Qian Yao, Ying-Shi Sun
Hai-Bin Zhu, Bo Zhao, Xiao-Ting Li, Xiao-Yan Zhang, Ying-Shi Sun, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Qian Yao, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
Co-first authors: Hai-Bin Zhu and Bo Zhao.
Author contributions: Zhu HB and Zhao B contributed equally to this work; Zhu HB, Zhao B, Li XT, Zhang XY and Sun YS designed the research study; Zhu HB, Zhao B, Li XT, Zhang XY and Sun YS performed the research; Li XT and Yao Q contributed new reagents and analytic tools; Zhu HB, Zhao B, Li XT and Yao Q analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Supported by Beijing Hospitals Authority Youth Program, No. QML20231103; Beijing Hospitals Authority Ascent Plan, No. DFL20191103; and National Key R&D Program of China, No. 2023YFC3402805.
Institutional review board statement: This study was conducted in accordance with the regulations and guidelines established by the Medical Ethics Committee (IRB) of Beijing Cancer Hospital. All studies involving human subjects were conducted with IRB approval.
Informed consent statement: Informed consent was waived due to the retrospective study.
Conflict-of-interest statement: The authors declared no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Shi Sun, MD, Chief Physician, Professor, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiology, Peking University Cancer Hospital and Institute, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. sys27@163.com
Received: November 6, 2023
Peer-review started: November 6, 2023
First decision: November 30, 2023
Revised: December 15, 2023
Accepted: January 10, 2024
Article in press: January 10, 2024
Published online: January 28, 2024
Processing time: 80 Days and 22.3 Hours
Abstract
BACKGROUND

About 10%-31% of colorectal liver metastases (CRLM) patients would concomitantly show hepatic lymph node metastases (LNM), which was considered as sign of poor biological behavior and a relative contraindication for liver resection. Up to now, there’s still lack of reliable preoperative methods to assess the status of hepatic lymph nodes in patients with CRLM, except for pathology examination of lymph node after resection.

AIM

To compare the ability of mono-exponential, bi-exponential, and stretched-exponential diffusion-weighted imaging (DWI) models in distinguishing between benign and malignant hepatic lymph nodes in patients with CRLM who received neoadjuvant chemotherapy prior to surgery.

METHODS

In this retrospective study, 97 CRLM patients with pathologically confirmed hepatic lymph node status underwent magnetic resonance imaging, including DWI with ten b values before and after chemotherapy. Various parameters, such as the apparent diffusion coefficient from the mono-exponential model, and the true diffusion coefficient, the pseudo-diffusion coefficient, and the perfusion fraction derived from the intravoxel incoherent motion model, along with distributed diffusion coefficient (DDC) and α from the stretched-exponential model (SEM), were measured. The parameters before and after chemotherapy were compared between positive and negative hepatic lymph node groups. A nomogram was constructed to predict the hepatic lymph node status. The reliability and agreement of the measurements were assessed using the coefficient of variation and intraclass correlation coefficient.

RESULTS

Multivariate analysis revealed that the pre-treatment DDC value and the short diameter of the largest lymph node after treatment were independent predictors of metastatic hepatic lymph nodes. A nomogram combining these two factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients, with an area under the curve of 0.873. Furthermore, parameters from SEM showed substantial repeatability.

CONCLUSION

The developed nomogram, incorporating the pre-treatment DDC and the short axis of the largest lymph node, can be used to predict the presence of hepatic LNM in CRLM patients undergoing chemotherapy before surgery. This nomogram was proven to be more valuable, exhibiting superior diagnostic performance compared to quantitative parameters derived from multiple b values of DWI. The nomogram can serve as a preoperative assessment tool for determining the status of hepatic lymph nodes and aiding in the decision-making process for surgical treatment in CRLM patients.

Keywords: Colorectal cancer; Individualized treatment; Diffusion magnetic resonance imaging; Intravoxel incoherent motion; Liver

Core Tip: This study compared the diagnostic effectiveness of mono-exponential, bi-exponential, and stretched exponential Diffusion-weighted magnetic resonance imaging in predicting hepatic lymph node metastases (LNM) in patients with colorectal liver metastases after chemotherapy. Our finding indicated that only the pre-treatment distributed diffusion coefficient value and the short diameter of the largest lymph node after treatment were independent predictors of hepatic LNM. We developed a nomogram incorporating these two factors to non-invasively and individually predict the status of hepatic lymph nodes, demonstrating significant potential in surgical planning and assessing high-risk patients.