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Metastases in Mediastinal and Hilar Lymph Nodes in Patients with Non–Small Cell Lung Cancer: Quantitative and Qualitative Assessment with STIR Turbo Spin-Echo MR Imaging¹

¹ From the Dept of Radiology (Y.O., T.H., H.W., K.S.), Div of Cardiovascular, Thoracic and Pediatric Surgery (M.Y.), and Div of Cardiovascular and Respiratory Medicine, Dept of Internal Medicine (M.S., Y.N.), Kobe Univ Graduate School of Medicine, 7–5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan; Dept of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (H.H.); Dept of Radiology, Kasai Municipal Hosp, Hyogo, Japan (D.T.); and Div of Pathology, Kobe University Hosp, Japan (C.O.). From the 2002 RSNA scientific assembly. Received Jan 15, 2003; revision requested Mar 25; final revision received Sep 2; accepted Sep 25. Address correspondence to Y.O. (e-mail: yosirad@kobe-u.ac.jp).

View larger version (132K): [in a new window]   Figure 1. Images in 75-year-old man with lymph nodes containing metastasis from adenocarcinoma. A, Transverse contrast-enhanced CT scan shows lower paratracheal nodes. B, Transverse STIR TSE MR image (repetition time msec/effective echo time msec/inversion time msec, 1,200/15/150) shows lymph nodes as high-signal-intensity areas (arrows). One of these three lymph nodes was 4 mm in short-axis diameter; the other two were 3 mm in short-axis diameter. LSRs of these lymph nodes were 0.85 and 0.89. Analysis of histologic specimen from lower paratracheal node revealed nodular lesions composed of metastasizing poorly differentiated adenocarcinoma (ie, invasive growth of neoplastic cells among normal lymphoid tissue).

View larger version (100K): [in a new window]   Figure 2. Images in 58-year-old woman with lymph nodes free of metastasis from adenocarcinoma. A, Transverse contrast-enhanced CT scan shows two lower paratracheal and two subaortic nodes. B, Transverse STIR TSE MR image (1,200/15/150) shows these lymph nodes as low-signal-intensity areas (arrows). Short-axis diameters of these lymph nodes ranged between 3 and 11 mm. LSRs of these lymph nodes ranged between 0.29 and 0.37. Analysis of histologic specimen of subaortic lymph node revealed no evidence of metastatic tumor cell nests or fibrotic scars.

View larger version (34K): [in a new window]   Figure 3. Graph shows results with receiver operating characteristic-based positive test of each lymph node size group at quantitative analysis with the LSR on a per-node basis. = sensitivity for size group A nodes, = specificity for size group A nodes, = sensitivity for size group B nodes, = specificity for size group B nodes, = sensitivity for size group C nodes, = specificity for size group C nodes. An LSR of 0.6 was adopted as the threshold for a positive test for all size groups.

View larger version (24K): [in a new window]   Figure 4. Graph shows results with receiver operating characteristic-based positive test at qualitative analysis with a five-point scoring system on a per-node basis. = sensitivity, = specificity. At qualitative analysis, a rated signal intensity score of 4 was adopted as the threshold for a positive test (ie, a score 4 indicated that a lymph node contained metastasis).