The sensitivity and specificity for the prediction of lymph node metastasis based on morphological criteria were 40% and 63% for reader 1 and 30% and 88% for reader 2 respectively. Histogram analyses did not add any significant additional value. The optimal cut off value was 1179 * 10-3 mm2/s with an area under the curve (AUC) of 0.83 and a sensitivity and specificity of 81% and 86% respectively to predict advanced tumors. There was a significant difference between the mean ADC-value of advanced versus early tumors (p = 0.002). The sensitivity and specificity in predicting lymph node metastasis was calculated for both readers and for the ADC-value of the primary tumor, with histopathology results as the gold standard. To compare the accuracy of lymph node metastasis (N+) prediction based on morpholigical criteria versus ADC-value of the primary tumor, two blinded readers, determined the lymph node metastasis (N0 vs N+) based on morphological criteria. The student Mann Whitney U-test was used to assess the differences between the ADC means of early and advanced colon cancer. Advanced colon cancer was defined as lymph node mestastasis (N+) or distant metastasis (M+). An expert reader manually delineated all colon tumors to measure mean ADC and histogram metrics (mean, min, max, median, standard deviation (SD), skewness, kurtosis, 5th-95th percentiles) were calculated. ADC maps were calculated for each patient. All patients received a 1.5T MRI of the colon including T2 and DWI sequences. Thirty patients (21M, 9F) were included retrospectively. To investigate the role of the apparent diffusion coefficient (ADC) as a potential imaging biomarker to predict metastasis (lymph node metastasis and distant metastasis) in colon cancer based on the ADC-value of the primary tumor.
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