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Acta Radiol. 2018 Jun;59(6):672-680. doi: 10.1177/0284185117730688. Epub 2017 Sep 4.

Histogram analysis of apparent diffusion coefficient maps for the differentiation between lymphoma and metastatic lymph nodes of squamous cell carcinoma in head and neck region.

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1 Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, PR China.
2 Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, PR China.


Background To clarify the nature of cervical malignant lymphadenopathy is highly important for the diagnosis and differential diagnosis of head and neck tumors. Purpose To investigate the role of first-order apparent diffusion coefficient (ADC) histogram analysis for differentiating lymphoma from metastatic lymph nodes of squamous cell carcinoma (SCC) in the head and neck region. Material and Methods Diffusion-weighted imaging (DWI) data of 67 patients (lymphoma, n = 20; SCC, n = 47) with malignant lymphadenopathy were retrospectively analyzed. The SCC group was divided into nasopharyngeal SCC and non-nasopharyngeal SCC groups. The ADC histogram features (ADC10, ADC25, ADCmean, ADCmedian, ADC75, ADC90, skewness, and kurtosis) were derived and then compared by independent-samples t-test and one-way analysis of variance test, respectively. Receiver operating characteristic curve analyses were employed to investigate diagnostic performance of the significant parameters. Results Lymphoma showed significantly lower ADCmean, ADCmedian, ADC75, and ADC90 than SCC (all P < 0.05). Setting ADC90 = 0.719 × 10-3 mm2/s as the threshold value, optimal diagnostic performance was achieved (area under the curve [AUC] = 0.719, sensitivity = 95.7%, specificity = 50.0%). Subgroup analyses showed no significant difference between lymphoma and NPC (all P > 0.05). Lymphoma showed significantly lower ADC25, ADCmean, ADCmedian, ADC75, and ADC90 than non-nasopharyngeal SCC (all P < 0.05). Optimal diagnostic performance (AUC = 0.847, sensitivity = 86.7%, specificity = 80.0%) could be achieved when setting ADC90 = 0.943 × 10-3 mm2/s as the threshold value. Conclusion Given its limitations, our study has shown that first-order ADC histogram analysis is capable of differentiating lymphoma from metastatic lymph nodes of SCC, especially those of non-nasopharyngeal SCC.


Malignant lymph node; apparent diffusion coefficient; differential diagnosis; diffusion-weighted imaging; histogram analysis

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