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
ARTICLE HIGHLIGHTS
Research background

More than 50% of patients with colorectal cancer develop colorectal liver metastases (CRLM), and the presence of metastatic hepatic lymph nodes can greatly influence treatment decisions and patient outcomes. Precise preoperative prediction of hepatic lymph node status is beneficial for individualized treatment and reducing complications.

Research motivation

However, there is currently a lack of reliable radiological tools for predicting the presence of metastatic hepatic lymph nodes in CRLM prior to surgery.

Research objectives

The study aimed to assess the predictive ability of different diffusion-weighted imaging (DWI) models (mono-exponential, bi-exponential, and stretched-exponential) in distinguishing between benign and malignant hepatic lymph nodes in CRLM patients who underwent neoadjuvant chemotherapy.

Research methods

A retrospective study was conducted involving 97 CRLM patients with pathologically confirmed hepatic lymph node status who underwent magnetic resonance imaging, including DWI with ten b values before and after chemotherapy. Various parameters, including apparent diffusion coefficient, the true diffusion coefficient, the pseudo-diffusion coefficient, the perfusion fraction, distributed diffusion coefficient (DDC), and α, derived from different DWI models, were measured and compared between positive and negative hepatic lymph node groups. A nomogram was constructed, and the reliability and agreement of the measurements were assessed using appropriate statistical analyses.

Research 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 factors demonstrated excellent performance in distinguishing between benign and malignant lymph nodes in CRLM patients, with area under the receiver operating characteristic curve of 0.873. Furthermore, parameters from the stretched-exponential model showed substantial repeatability.

Research conclusions

The developed nomogram, incorporating the pre-treatment DDC and the short axis of the largest lymph node, can be utilized to predict the presence of hepatic lymph node metastases in CRLM patients who undergo chemotherapy prior to surgery. This nomogram was found to be more valuable than quantitative parameters derived from multiple b values of DWI, exhibiting superior diagnostic performance.

Research perspectives

In the future, 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.