Differentiation of metastatic versus non-metastatic mediastinal lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo MR imaging

Objectives: To differentiate between metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer using respiratory-triggered short inversion time inversion recovery (STIR) turbo spin-echo (SE) MR imaging. Methods and patients: One hundred and forty mediastinal lymph nodes were detected in 25 patients with non-small cell lung cancer who underwent respiratory-triggered STIR turbo SE imaging. Ratios of signal intensity of lymph nodes to 0.9% saline phantoms (lymph node-saline ratio) were compared by Student's t-test using the pathological diagnosis as the gold standard. The threshold value of the lymph node-saline ratio was determined for a positive test, and tested for its capability to provide a differential diagnosis. Results: One hundred and forty lymph nodes were diagnosed and classified into two groups: metastatic lymph node (n=21) and non-metastatic lymph node (n=119). The mean lymph node-saline ratio in the non-metastatic lymph node group (0.42±0.01; mean±standard error) was significantly lower than that of the metastatic lymph node group (0.77±0.02, P<0.0001). When 0.6 was adapted as the threshold for a positive test, sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per lymph nodes were 100, 96, and 96%, and sensitivity, specificity, and accuracy for differentiating metastatic lymph node from non-metastatic lymph node per patients were 100, 75, and 88%, respectively. Conclusions: Both metastatic and non-metastatic lymph nodes in patients with non-small cell lung cancer were well differentiated using respiratory-triggered STIR turbo SE imaging.