• Sang Ok Park, Jeong Kon Kim, Kyoung Ah Kim, Bum-Woo Park, Namkug Kim, Gyunggoo Cho, Hyuk Jae Choi, and Kyoung-Sik Cho.
• Department of Radiology, University of Ulsan, Seoul, South Korea.
• J Magn Reson Imaging. 2009 Feb 1; 29 (2): 383-90.

PurposeTo determine the reference site for relative apparent diffusion coefficient (rADC) and to evaluate the benefit of rADC for detecting metastatic lymph nodes in uterine cervical cancer.Materials And MethodsTwo observers independently measured ADCs in the spleen, liver, renal cortex, lumbar spine, lumbar spinal cord, and gluteus maximus on diffusion-weighted images (b value, 0 and 1000 mm/sec(2)) in 50 patients. The reference site for rADC was determined using the intra- and interobserver coefficient of variation (CV) of ADC in these organs. rADC was calculated by ADC(lesion)/ADC(reference site). The benefit of rADC over ADC was validated by comparing the area under the receiver operating curve for identifying metastatic lymph nodes in uterine cervical cancer in 130 patients.ResultsThe renal cortex was determined to be the reference site for rADC, as its CVs (intraobserver, 5%-7%; interobserver, 5%) were less than those of the other organs (P < 0.05). The ADC and rADC of metastatic lymph nodes (n = 29, ADC, 0.7483 x 10(-3) mm(2)/sec; rADC, 0.3832) were less than those of nonmetastatic lymph nodes (n = 229, ADC, 0.9960 x 10(-3) mm(2)/sec; rADC, 0.5383) (P < 0.05). The area under the receiver operating characteristics curve for differentiating metastatic from nonmetastatic lymph nodes was greater for rADC (0.914; 95% confidence interval [CI], 0.872-0.945) than for ADC (0.872; 95% CI, 0.825-0.910) (P = 0.007).ConclusionThe renal cortex is an appropriate reference site for rADC and rADC may improve the accuracy for diagnosing metastatic lymph nodes in uterine cervical cancer.

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