Can parameters other than minimal axial diameter in MRI and PET/CT further improve diagnostic accuracy for equivocal retropharyngeal lymph nodes in nasopharyngeal carcinoma?

Yu Wen Wang, Chin Shun Wu, Guo Yi Zhang, Chih-Han Chang, Kuo-Sheng Cheng, Wei-Jen Yao, Yu Kang Chang, Tsair Wei Chien, Li Ching Lin, Keng Ren Lin

Research output: Contribution to journalArticle

Abstract

Purpose: Minimal axial diameter (MIAD) in magnetic resonance imaging (MRI) was recognized as the most useful parameter in diagnosing lateral retropharyngeal lymph (LRPL) nodes in nasopharyngeal carcinoma (NPC). This study aims to explore the additional nodal parameters in MRI and positron emission tomography - computed tomography for increasing the prediction accuracy. Materials and Methods: A total of 663 LRPL nodes were retrospectively collected from 335 patients with NPC. The LRPL nodes ascertained on follow-up MRI were considered positive for metastases. First, the optimal cutoff value of each parameter was derived for each parameter. In addition, neural network (NN) nodal evaluation was tested for all combinations of three parameters, namely MIAD, maximal axial diameter (MAAD), and maximal coronal diameter (MACD). The optimal approach was determined through brute force attack, and the results of two methods were compared using a bootstrap sampling method. Second, the mean standard uptake value (NSUVmean) was added as the fourth parameter and tested in the same manner for 410 nodes in 219 patients. Results: In first and second analysis, the accuracy rate (percentage) for the MIAD was 89.0% (590/663) and 89.0% (365/410), with the optimal cutoff values being 6.1 mm and 6.0 mm, respectively. With the combination of all three and four parameters, the accuracy rate of the NN was 89% (288/332) and 88.8% (182/205), respectively. In prediction, the optimal combinations of the three and four parameters resulted in correct identification of three (accuracy: 593/663, 89.4%) and six additional nodes (371/410, 90.5%), representing 4% (3/73) and 13.3% (6/45) decreases in incorrect prediction, respectively. Conclusion: NPC LRPL nodes with an MIAD ≥ 6.1 mm are positive. Among nodes with an MIAD < 6.1 mm, if the NSUVmean ≥ 2.6 or MACD ≥ 25 mm and MAAD ≥ 8 mm, the nodes are positive; otherwise, they are negative.

Original languageEnglish
Article numbere0163741
JournalPloS one
Volume11
Issue number10
DOIs
Publication statusPublished - 2016 Oct 1

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Magnetic resonance
magnetic resonance imaging
carcinoma
lymph nodes
Lymph Nodes
Magnetic Resonance Imaging
Imaging techniques
Neural networks
Positron emission tomography
Tomography
Sampling
neural networks
prediction
Neoplasm Metastasis
Nasopharyngeal carcinoma
positron-emission tomography
computed tomography
metastasis
methodology

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Wang, Yu Wen ; Wu, Chin Shun ; Zhang, Guo Yi ; Chang, Chih-Han ; Cheng, Kuo-Sheng ; Yao, Wei-Jen ; Chang, Yu Kang ; Chien, Tsair Wei ; Lin, Li Ching ; Lin, Keng Ren. / Can parameters other than minimal axial diameter in MRI and PET/CT further improve diagnostic accuracy for equivocal retropharyngeal lymph nodes in nasopharyngeal carcinoma?. In: PloS one. 2016 ; Vol. 11, No. 10.
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title = "Can parameters other than minimal axial diameter in MRI and PET/CT further improve diagnostic accuracy for equivocal retropharyngeal lymph nodes in nasopharyngeal carcinoma?",
abstract = "Purpose: Minimal axial diameter (MIAD) in magnetic resonance imaging (MRI) was recognized as the most useful parameter in diagnosing lateral retropharyngeal lymph (LRPL) nodes in nasopharyngeal carcinoma (NPC). This study aims to explore the additional nodal parameters in MRI and positron emission tomography - computed tomography for increasing the prediction accuracy. Materials and Methods: A total of 663 LRPL nodes were retrospectively collected from 335 patients with NPC. The LRPL nodes ascertained on follow-up MRI were considered positive for metastases. First, the optimal cutoff value of each parameter was derived for each parameter. In addition, neural network (NN) nodal evaluation was tested for all combinations of three parameters, namely MIAD, maximal axial diameter (MAAD), and maximal coronal diameter (MACD). The optimal approach was determined through brute force attack, and the results of two methods were compared using a bootstrap sampling method. Second, the mean standard uptake value (NSUVmean) was added as the fourth parameter and tested in the same manner for 410 nodes in 219 patients. Results: In first and second analysis, the accuracy rate (percentage) for the MIAD was 89.0{\%} (590/663) and 89.0{\%} (365/410), with the optimal cutoff values being 6.1 mm and 6.0 mm, respectively. With the combination of all three and four parameters, the accuracy rate of the NN was 89{\%} (288/332) and 88.8{\%} (182/205), respectively. In prediction, the optimal combinations of the three and four parameters resulted in correct identification of three (accuracy: 593/663, 89.4{\%}) and six additional nodes (371/410, 90.5{\%}), representing 4{\%} (3/73) and 13.3{\%} (6/45) decreases in incorrect prediction, respectively. Conclusion: NPC LRPL nodes with an MIAD ≥ 6.1 mm are positive. Among nodes with an MIAD < 6.1 mm, if the NSUVmean ≥ 2.6 or MACD ≥ 25 mm and MAAD ≥ 8 mm, the nodes are positive; otherwise, they are negative.",
author = "Wang, {Yu Wen} and Wu, {Chin Shun} and Zhang, {Guo Yi} and Chih-Han Chang and Kuo-Sheng Cheng and Wei-Jen Yao and Chang, {Yu Kang} and Chien, {Tsair Wei} and Lin, {Li Ching} and Lin, {Keng Ren}",
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Can parameters other than minimal axial diameter in MRI and PET/CT further improve diagnostic accuracy for equivocal retropharyngeal lymph nodes in nasopharyngeal carcinoma? / Wang, Yu Wen; Wu, Chin Shun; Zhang, Guo Yi; Chang, Chih-Han; Cheng, Kuo-Sheng; Yao, Wei-Jen; Chang, Yu Kang; Chien, Tsair Wei; Lin, Li Ching; Lin, Keng Ren.

In: PloS one, Vol. 11, No. 10, e0163741, 01.10.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Can parameters other than minimal axial diameter in MRI and PET/CT further improve diagnostic accuracy for equivocal retropharyngeal lymph nodes in nasopharyngeal carcinoma?

AU - Wang, Yu Wen

AU - Wu, Chin Shun

AU - Zhang, Guo Yi

AU - Chang, Chih-Han

AU - Cheng, Kuo-Sheng

AU - Yao, Wei-Jen

AU - Chang, Yu Kang

AU - Chien, Tsair Wei

AU - Lin, Li Ching

AU - Lin, Keng Ren

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Purpose: Minimal axial diameter (MIAD) in magnetic resonance imaging (MRI) was recognized as the most useful parameter in diagnosing lateral retropharyngeal lymph (LRPL) nodes in nasopharyngeal carcinoma (NPC). This study aims to explore the additional nodal parameters in MRI and positron emission tomography - computed tomography for increasing the prediction accuracy. Materials and Methods: A total of 663 LRPL nodes were retrospectively collected from 335 patients with NPC. The LRPL nodes ascertained on follow-up MRI were considered positive for metastases. First, the optimal cutoff value of each parameter was derived for each parameter. In addition, neural network (NN) nodal evaluation was tested for all combinations of three parameters, namely MIAD, maximal axial diameter (MAAD), and maximal coronal diameter (MACD). The optimal approach was determined through brute force attack, and the results of two methods were compared using a bootstrap sampling method. Second, the mean standard uptake value (NSUVmean) was added as the fourth parameter and tested in the same manner for 410 nodes in 219 patients. Results: In first and second analysis, the accuracy rate (percentage) for the MIAD was 89.0% (590/663) and 89.0% (365/410), with the optimal cutoff values being 6.1 mm and 6.0 mm, respectively. With the combination of all three and four parameters, the accuracy rate of the NN was 89% (288/332) and 88.8% (182/205), respectively. In prediction, the optimal combinations of the three and four parameters resulted in correct identification of three (accuracy: 593/663, 89.4%) and six additional nodes (371/410, 90.5%), representing 4% (3/73) and 13.3% (6/45) decreases in incorrect prediction, respectively. Conclusion: NPC LRPL nodes with an MIAD ≥ 6.1 mm are positive. Among nodes with an MIAD < 6.1 mm, if the NSUVmean ≥ 2.6 or MACD ≥ 25 mm and MAAD ≥ 8 mm, the nodes are positive; otherwise, they are negative.

AB - Purpose: Minimal axial diameter (MIAD) in magnetic resonance imaging (MRI) was recognized as the most useful parameter in diagnosing lateral retropharyngeal lymph (LRPL) nodes in nasopharyngeal carcinoma (NPC). This study aims to explore the additional nodal parameters in MRI and positron emission tomography - computed tomography for increasing the prediction accuracy. Materials and Methods: A total of 663 LRPL nodes were retrospectively collected from 335 patients with NPC. The LRPL nodes ascertained on follow-up MRI were considered positive for metastases. First, the optimal cutoff value of each parameter was derived for each parameter. In addition, neural network (NN) nodal evaluation was tested for all combinations of three parameters, namely MIAD, maximal axial diameter (MAAD), and maximal coronal diameter (MACD). The optimal approach was determined through brute force attack, and the results of two methods were compared using a bootstrap sampling method. Second, the mean standard uptake value (NSUVmean) was added as the fourth parameter and tested in the same manner for 410 nodes in 219 patients. Results: In first and second analysis, the accuracy rate (percentage) for the MIAD was 89.0% (590/663) and 89.0% (365/410), with the optimal cutoff values being 6.1 mm and 6.0 mm, respectively. With the combination of all three and four parameters, the accuracy rate of the NN was 89% (288/332) and 88.8% (182/205), respectively. In prediction, the optimal combinations of the three and four parameters resulted in correct identification of three (accuracy: 593/663, 89.4%) and six additional nodes (371/410, 90.5%), representing 4% (3/73) and 13.3% (6/45) decreases in incorrect prediction, respectively. Conclusion: NPC LRPL nodes with an MIAD ≥ 6.1 mm are positive. Among nodes with an MIAD < 6.1 mm, if the NSUVmean ≥ 2.6 or MACD ≥ 25 mm and MAAD ≥ 8 mm, the nodes are positive; otherwise, they are negative.

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