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. 2019 Mar 5;92(1097):20181044. doi: 10.1259/bjr.20181044

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.

a

Definition of lymph nodes considered metastatic on MRI.

b

Results are directly deduced from article, no raw data was reported so no 2-by-2 contingency tables could be reconstructed.

c

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).

d

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.