Diffusion tensor imaging in characterization of cervical lymphadenopathy

Background It is important to differentiate cervical lymph nodes. So, this study aims to assess the ability of diffusion tensor imaging (DTI) in differentiating cervical lymphadenopathy (LNs). Materials and methods This retrospective study was done upon 100 patients with cervical LNs who had DTI over a year period. The fractional anisotropy (FA) and the mean diffusivity (MD) values of LNs were measured. Results This study was done upon 100 patients (the mean age 45 ± 2 years (standard deviation [SD]), 63 men). The mean MD and FA of the malignant LNs (0.83 ± 0.14 × 10 −3 mm 2 /s, 0.26 ± 0.07) were significantly different; ( P = 0.001) than those of benign LNs (1.32 ± 0.33 × 10 –3 mm 2 /s, 0.22 ± 0.09). MD of 0.94 × 10 –3 mm 2 /s and FA of 0.21 were used to discriminate malignant and benign LNs, AUC 0.892 and 0.758, and 84% and 71% accuracy, respectively. Combined parameters revealed AUC of 0.914 and 81%. The mean MD and FA of the metastatic LNs (0.86 ± 0.12 × 10 –3 mm 2 /s, 0.25 ± 0.07) were statistically different; ( P = 0.001, 0.03) than those of lymphomatous nodes (0.66 ± 0.13 × 10 –3 mm 2 /s, 0.28 ± 0.02). The AUC of the MD and FA used to distinguish metastatic from lymphomatous nodes was 0.82, 0.711, (0.71 × 10 –3 mm 2 /s, 0.27) cutoff values, and 95.3%, 73.4% accuracy, respectively. Combined parameters revealed 0.824 AUC, 95.3% accuracy, 98.2% sensitivity, and 75% specificity. There was a significant statistical difference in MD between well-moderately ( P = 0.001) versus poorly differentiated metastatic LNs and stages I and II ( P = 0.018) versus stages III and IV of metastatic cervical LNs. Conclusions Combining FA and MD is a promising technique that can play a major role in distinguishing different categories of cervical LNs.