Whole-Lesion Apparent Diffusion Coefficient Histogram Analysis for Assessing Normal-Sized Lymph Node Metastasis in Cervical Cancer: Comparison Between Readout-Segmented and Single-Shot Echo-Planar Diffusion-Weighted Imaging

Objective To compare the value of whole-lesion apparent diffusion coefficient (ADC) histogram analysis derived from readout-segmented echo-planar imaging (RS-EPI) and single-shot echo-planar imaging (SS-EPI) diffusion-weighted imaging (DWI) in evaluating normal-sized lymph node metastasis (LNM) in cervical cancer. Methods Seventy-six pathologically confirmed cervical cancer patients (stages IB and IIA) were enrolled, including 61 patients with non-LNM (group A) and 15 patients with normal-sized LNM (group B). The recorded tumor volume on T2-weighted imaging was the reference against which both DWIs were evaluated. Each ADC histogram parameter (including ADC max , ADC 90 , ADC median , ADC mean , ADC 10 , ADC min , ADC skewness , ADC kurtosis , and ADC entropy ) was compared between SS-EPI and RS-EPI and between the 2 groups. Results There was no significant difference in tumor volume between the 2 DWIs and T2-weighted imaging (both P > 0.05). Higher ADC max and ADC entropy but lower ADC 10 , ADC min and ADC skewness were found in SS-EPI than those in RS-EPI (all P < 0.05). For SS-EPI, lower ADC 90 and higher ADC kurtosis were found in group B than those in group A (both P < 0.05). For RS-EPI, lower ADC 90 and higher ADC kurtosis and ADC entropy were found in group B than those in group A (all P < 0.05). Readout-segmented echo-planar imaging ADC kurtosis showed the highest area under the curve of 0.792 in the differentiation of the 2 groups (sensitivity, 80%; specificity, 73.77%). Conclusions Compared with SS-EPI, the ADC histogram parameters derived from RS-EPI were more accurate, and ADC kurtosis held great potential in differentiating normal-sized LNM in cervical cancer.