胰腺导管腺癌区域淋巴结转移的Node-RADS评分：CT与MRI诊断效能及预后价值比较

PURPOSE: To compare the diagnostic performance and prognostic impact of the Node Reporting and Data System (Node-RADS) for regional lymph node (LN) metastasis in pancreatic ductal adenocarcinoma (PDAC) via preoperative CT and MRI.

METHODS: This single-center retrospective study included patients with PDAC who underwent contrast-enhanced CT and MRI before pancreatectomy between January 2016 and December 2022. Node-RADS scores were assigned to resected LN stations on both modalities, with histopathology as reference. Sensitivity and specificity were evaluated at the patient, LN group, and station levels and compared using the McNemar test. Cox regression analysis examined associations between Node-RADS and overall survival (OS) after adjusting for clinicopathologic characteristics.

RESULTS: Of 188 patients included (mean age, 67.4 ± 8.9 years; 90 men), 118 (62.8%) exhibited LN metastases. A Node-RADS score ≥ 3 achieved the highest Youden index on both modalities, with CT and MRI demonstrating equivalent performance for predicting LN metastasis (sensitivity, 80.5% vs. 78.0%, P = 0.678; specificity, 80.0% vs. 85.7%, P = 0.289). At the LN group and station levels, Node-RADS ≥ 3 on CT and MRI yielded consistently comparable results, with sensitivities and specificities ranging from 50.0%-85.7% and 75.0%-98.7% for CT, and from 50.0%-72.7% and 75.0%-98.7% for MRI, respectively. In separate multivariable Cox models, Node-RADS ≥3 on both CT and MRI independently predicted poorer OS (CT: hazard ratio [HR], 1.99; MRI: HR, 1.93; both P < 0.001).

CONCLUSION: Both CT- and MRI-based Node-RADS demonstrated comparable diagnostic performance for regional LN metastasis and provided significant prognostic stratification for OS in PDAC.