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World J Gastroenterol. Apr 14, 2008; 14(14): 2208-2212
Published online Apr 14, 2008. doi: 10.3748/wjg.14.2208
Comparison of CT and MRI for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma
Young Chul Kim, Mi-Suk Park, Seung-Whan Cha, Yong Eun Chung, Joon Suk Lim, Kyung Sik Kim, Myeong-Jin Kim, Ki Whang Kim
Young Chul Kim, Mi-Suk Park, Yong Eun Chung, Joon Suk Lim, Myeong-Jin Kim, Ki Whang Kim, Department of Diagnostic Radiology and Institute of Gastroenterology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 120-752, Korea
Seung-Whan Cha, Department of Diagnostic radiology and Institute of Gastroenterology, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
Kyung Sik Kim, Department of General surgery and Institute of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, Korea
Author contributions: MS Park designed study concept; Kim YC collected data; Park MS, Cha SW analyzed and interpreted data; YC Kim, MS Park Drafted the manuscrip; Park MS, Chung YE, Kim KS critically revised the manuscript for important intellectual content; Lim JS statistical analysis; Park MS, Kim MJ, KW Kim were responsible for administrative, technical, or material support.
Correspondence to: Mi-Suk Park, MD, Department of Diagnostic Radiology, Severance Hospital, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Korea. radpms@yuhs.ac
Telephone: +82-22-2287400
Fax: +82-23-933035
Received: October 16, 2007
Revised: December 7, 2007
Published online: April 14, 2008
Abstract

AIM: To determine the accuracy of computed tomography (CT) and magnetic resonance (MR) for presurgical characterization of paraaortic lymph nodes in patients with pancreatico-biliary carcinoma.

METHODS: Two radiologists independently evaluated CT and MR imaging of 31 patients who had undergone lymphadenectomy (9 metastatic and 22 non-metastatic paraaortic nodes). Receiver operating characteristic (ROC) curve analysis was performed using a five point scale to compare CT with MRI. To re-define the morphologic features of metastatic nodes, we evaluated CT scans from 70 patients with 23 metastatic paraaortic nodes and 47 non-metastatic ones. The short axis diameter, ratio of the short to long axis, shape, and presence of necrosis were compared between metastatic and non-metastatic nodes by independent samples t-test and Fisher’s exact test. P < 0.05 was considered statistically significant.

RESULTS: The mean area under the ROC curve for CT (0.732 and 0.646, respectively) was slightly higher than that for MRI (0.725 and 0.598, respectively) without statistical significance (P = 0.940 and 0.716, respectively). The short axis diameter of the metastatic lymph nodes (mean = 9.2 mm) was significantly larger than that of non-metastatic ones (mean = 5.17 mm, P < 0.05). Metastatic nodes had more irregular margins (44.4%) and central necrosis (22.2%) than non-metastatic ones (9% and 0%, respectively), with statistical significance (P < 0.05).

CONCLUSION: The accuracy of CT scan for the characterization of paraaortic nodes is not different from that of MRI. A short axis-diameter (> 5.3 mm), irregular margin, and presence of central necrosis are the suggestive morphologic features of metastatic paraaortic nodes.

Keywords: Paraaortic lymph node, Pancreatico-biliary carcinoma, Computed tomography, Magnetic resonance imaging