Abstract
PurposeTo evaluate the diagnostic efficacy in differentiating metastatic from inflammatory perigastric lymph nodes (LNs) in patients with gastric cancer by using CT perfusion imaging (CTPI). MethodA total of 115 annotated perigastric LNs of 50 patients with gastric cancer confirmed by pathology underwent CTPI scan before operation. The scan data were postprocessed to acquire perfusion maps and parameters including blood flow (BF) and permeability surface (PS). A radiologist measured the short and long axis diameters, the short/long axis ratio and perfusion parameters of LNs. According to the post-operative pathology result, LNs were divided into two groups: metastatic and inflammatory nodes. Perfusion parameters and the size of LNs between two groups were respectively compared statistically, and a receiver-operating characteristic (ROC) curve analysis was used to determine the optimal diagnostic cutoff value with sensitivity, specificity and area under the curve (AUC). ResultsThe mean values of perfusion parameters and the short/long axis diameters ratio in metastatic and inflammatory LNs, respectively, were BF of 91.64 vs. 79.35 ml/100 mg /min (p < 0.01), PS of 43.42 vs. 35.92 ml/100 mg /min (p < 0.01), and the size ratio of 0.75 vs. 0.68 (p < 0.01). The sensitivity of 85.3%, specificity of 66.0 % and AUC of 0.816 for BF with cutoff value of 80.76 ml/100 mg /min for differentiating metastatic from inflammatory nodes were higher than those of PS or the size of LNs (p < 0.05). ConclusionsBF may be a reliable diagnostic marker of metastatic perigastric LNs in gastric cancer.
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