Table 3. .
Overview of clinical studies assessing the diagnostic performance of MRI for N-staging in patients with gastric cancer
| Author | Year | n | Age (years), mean[range] |
Male
n (%) |
MR image acquisition | Definition of pathologic lymph nodes a | Accuracy, % (95% CI) |
PPV, %
(95% CI) |
NPV, %
(95% CI) |
Sensitivity, % (95% CI) |
Specificity,
% (95% CI) |
|
| Differentiation between N0 and N+ (patient based values) | ||||||||||||
| Giganti,31 , b | 2016 | 52 | 69 [43-85] | 33 (63) | 1.5T, T2W, DCE, DWI (b-values 0–600) | Ø>6 mm and high SI on DWI | 71 (59–83) | 72 (60–84) | 70 (58–83) | 69 (57–82) | 73 (61–85) | |
| Liang32 | 2015 | 35 | 58 [38-75] | 21 (60) | 3.0T, DWI (b-value 800) | Not specified | 83 (66–93) | 94 (71–100) | 72 (47–90) | 76 (53–92) | 93 (66–100) | |
| Hasbahceci69 | 2015 | 23 | 59 [NR] | 11 (48) | 1.5T, T1W, T2W, DWI (b-values 50, 400, 800) | Ø≥5 mm and heterogenous SI, low ADC value (<1.1×10−3 mm2/s) | 65 (43–83) | 81 (54–96) | 29 (4–71) | 72 (47–90) | 40 (5–85) | |
| Joo33 | 2015 | 49 | 62 [38-81] | 33 (67) | 3.0T, T1W, T2W, DCE, DWI (b-values 0, 100, 500, 1000) | Ø≥8 mm or higher SI than muscle on DWI | 77 (62–88) | 79 (61–91) | 71 (42–92) | 87 (69–96) | 59 (33–82) | |
| Caivano35 | 2014 | 30 | 67 [29-84]c | 18 (58)c | 3.0T, T1W, T2W, DWI (b-values 0, 350, 750) | Ø>8 mm and signal characteristics like gastric neoplastic lesion | 100 (88–100) | 100 (85–100) | 100 (63–100) | 100 (85–100) | 100 (63–100) | |
| Lei38 | 2013 | 38 | 52 [31-82] | 26 (68) | 1.5T, T1W, T2W, DCE, DWI (b-value 600) | Perigastric Ø > 5 mm Distalis perigastric Ø > 6 mm |
85 (69–94) | 91 (71–99) | 77 (50–93) | 83 (63–95) | 87 (60–98) | |
| Kang44 | 2000 | 46 | 54 [26-69] | 34 (74) | 1.5T, T1W, DCE | Regional LN >8 mm or enhanced | 83 (69–92) | 91 (75–98) | 64 (35–87) | 85 (69–95) | 75 (43–95) | |
| Kim41 | 2000 | 26 | 56 [23-77] | 17 (65) | 1.0T, T1W, T2W | Ø>8 mm | 81 (61–93) | 100 (72–100) | 67 (38–88) | 69 (41–89) | 100 (69–100) | |
| Differentiation between N-stages (N0, N1, N2 or N3) | ||||||||||||
| Arslan,30 , b | 2017 | 51 | 61 [35-82] | 37 (73) | 1.5T, T2W, DWI (b-values 0, 400, 800) |
Ø≥8 mm or higher SI than muscle on DWI | N1 | NA | 60 (NA) | 92 (NA) | 75 (NA) | 85 (NA) |
| N2 | NA | 82 (NA) | 74 (NA) | 79 (NA) | 77 (NA) | |||||||
| N3 | NA | 86 (NA) | 91 (NA) | 60 (NA) | 98 (NA) | |||||||
| Zhong40 | 2005 | 15 | 63 [46-81] | 9 (60) | 1.0T, T1W, T2W, MR hydrography |
Ø>8 mm | 57 (29–82) | NR | NR | NR | NR | |
| Sohn43 | 2000 | 30 | 55 [37-77] | 19 (63) | 1.5T, T1W, T2W | Ø>8 mm | 55 (36–74) | NR | NR | NR | NR | |
| Differentiation between positive or negative individual lymph nodes (lymph node based values) | ||||||||||||
| Zhong70 , b | 2016 | 82 | 52 [24-77] | 65 (79) | 3.0T, T2W, DWI (b-values 0, 1000) | Ø>5 mm and/or central necrosis and/or indistinct border | NA | 64 (NA) | 79 (NA) | 73 (NA) | 70 (NA) | |
| iso-high/high signal intensity in DWI and iso-low/ low signal intensity on ADC map | NA | 65 (NA) | 81 (NA) | 77 (NA) | 70 (NA) | |||||||
| Cheng71 | 2013 | 28 | 64 [43-81] | 22 (79) | 1.5T, T1W, T2W, DCE, DWI (b-values 0, 400, 800) | Border irregularity T2W | 53 (41–65) | 57 (39–74) | 46 (31–63) | 48 (32–64) | 56 (38–73) | |
| Ø≥6 mm on conventional MR images | NA | 66 (NA) | 62 (NA) | 74 (NA) | 53 (NA) | |||||||
| Enhancement pattern (contrast-enhanced T1W) | 72 (61–82) | 89 (71–98) | 63 (48–77) | 57 (41–72) | 91 (76–98) | |||||||
| Size, border regularity and enhancement pattern | NA | 91 (NA) | 63 (NA) | 56 (NA) | 94 (NA) | |||||||
| ADC value (<1.39×10−3 mm2/s) | NA | 84 (NA) | 82 (NA) | 86 (NA) | 79 (NA) | |||||||
| ADC, size, border irregularity and enhanced pattern | NA | 88 (NA) | 77 (NA) | 78 (NA) | 89 (NA) | |||||||
| Tokuhara72 | 2008 | 31 | 68 [51-84] | 29 (94) | 1.5T, T2W, UPSIO | USPIO enhancement pattern d | 93 (91–95) | 76 (68–83) | 99 (97–100) | 96 (90–99) | 93 (90–95) | |
| Tatsumi73 | 2006 | 17 | 59 [52-75] | 14 (82) | 1.5T, T2W, USPIO | USPIO enhancement pattern d | 95 (91–98) | 86 (75–93) | 100 (97–100) | 100 (94–100) | 93 (87–96) | |
Ø, Short-axis diameter of lymph node considered metastatic; CI, confidence interval; DCE, dynamic contrast-enhanced; DWI, diffusion-weighted imaging; MR, magnetic resonance; NA, not available based on the results reported by the study; NPV, negative predictive value; NR, not reported; PPV, positive predictive value; SI, signal intensity; T, Tesla; T1W, T 1-weighted MRI; T2W, T 2-weighted MRI; USPIO, ultrasmall superparamagnetic iron oxide; n, number of patients.
Note. All studies used histopathology as a reference standard.
Definition of lymph nodes considered metastatic on MRI.
Results are directly deduced from article, no raw data was reported so no 2-by-2 contingency tables could be reconstructed.
In total, 31 patients were included in this study, however histology was only obtained in 30 patients. Age and sex are based on total study group (n = 31).
Lymph nodes with partial high signal intensity due to partial uptake or no blackening of nodes due to lack of uptake of USPIO were considered metastatic.