Histogram analysis of apparent diffusion coefficient maps for the differentiation between lymphoma and metastatic lymph nodes of squamous cell carcinoma in head and neck region

Abstract

Background

To clarify the nature of cervical malignant lymphadenopathy is highly important for the diagnosis and differential diagnosis of head and neck tumors.

Purpose

To investigate the role of first-order apparent diffusion coefficient (ADC) histogram analysis for differentiating lymphoma from metastatic lymph nodes of squamous cell carcinoma (SCC) in the head and neck region.

Material and Methods

Diffusion-weighted imaging (DWI) data of 67 patients (lymphoma, n = 20; SCC, n = 47) with malignant lymphadenopathy were retrospectively analyzed. The SCC group was divided into nasopharyngeal SCC and non-nasopharyngeal SCC groups. The ADC histogram features (ADC₁₀, ADC₂₅, ADC_mean, ADC_median, ADC₇₅, ADC₉₀, skewness, and kurtosis) were derived and then compared by independent-samples t-test and one-way analysis of variance test, respectively. Receiver operating characteristic curve analyses were employed to investigate diagnostic performance of the significant parameters.

Results

Lymphoma showed significantly lower ADC_mean, ADC_median, ADC₇₅, and ADC₉₀ than SCC (all P < 0.05). Setting ADC₉₀ = 0.719 × 10^–3mm²/s as the threshold value, optimal diagnostic performance was achieved (area under the curve [AUC] = 0.719, sensitivity = 95.7%, specificity = 50.0%). Subgroup analyses showed no significant difference between lymphoma and NPC (all P > 0.05). Lymphoma showed significantly lower ADC₂₅, ADC_mean, ADC_median, ADC₇₅, and ADC₉₀ than non-nasopharyngeal SCC (all P < 0.05). Optimal diagnostic performance (AUC = 0.847, sensitivity = 86.7%, specificity = 80.0%) could be achieved when setting ADC₉₀ = 0.943 × 10^–3mm²/s as the threshold value.

Conclusion

Given its limitations, our study has shown that first-order ADC histogram analysis is capable of differentiating lymphoma from metastatic lymph nodes of SCC, especially those of non-nasopharyngeal SCC.

Keywords

Malignant lymph node differential diagnosis diffusion-weighted imaging apparent diffusion coefficient histogram analysis

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