Node-RADS outperforms dual-energy CT-derived quantifications for distinguishing metastatic from non-metastatic regional lymph nodes in resectable gastric cancer.

Authors

Di-Xin Yao, Xiao-Xiao Lin, Tian-Xia Bei, Fei Ma, Yi Wang, Jing Li

Published in

European radiology. Nov 01, 2026. Epub Nov 01, 2026.

Abstract

To evaluate and compare the diagnostic performance of Node-RADS, dual-energy CT (DECT)-derived quantitative parameters, and their combination for distinguishing metastatic from non-metastatic regional lymph nodes (LNs) in patients with resectable gastric cancer (GC).
Between Jan 2022 and Oct 2025, 115 consecutive patients with resectable GC who underwent preoperative triple-phase enhanced DECT scans and radical gastrectomy with D2 lymphadenectomy were retrospectively enrolled. A total of 151 regional LNs (70 metastatic, 81 non-metastatic) with region-level pathological confirmation were selected for node-level comparison. Two radiologists independently assessed Node-RADS scores for each LN. LN short diameter (SD) was measured at the venous phase on the maximal axial slice. DECT-derived parameters (CT attenuation at 40 keV, iodine concentration (IC), and effective atomic number (Zeff) across arterial, venous, and delayed phases) were analyzed using a freehand region of interest on the maximal axial slice of the LN. Diagnostic performances were evaluated using receiver operating characteristic curve analysis and compared using the DeLong test.
IC at delayed phase (ICDP) was the sole parameter associated with LN involvement. The initial Node-RADS score (cut-off ≥ 3) achieved an AUC of 0.859 (95% CI: 0.793-0.910), significantly outperforming SD (AUC: 0.780, p < 0.05) and ICDP (AUC: 0.612, p < 0.05). Two modified Node-RADS algorithms incorporating ICDP under different rule-in and rule-out criteria were established, but did not improve diagnostic performance beyond the initial Node-RADS scores.
Node-RADS demonstrates superior diagnostic performance compared with DECT-derived quantitative parameters for identifying metastatic regional LNs in resectable GC, and can be reliably applied in the DECT settings.
Question Preoperative differentiation of metastatic from non-metastatic regional lymph nodes in resectable gastric cancer remains inaccurate using conventional size criteria. Findings Node-RADS  (AUC = 0.859) outperformed SD diameter (continuous: AUC = 0.780; its > 8 mm dichotomized counterpart: AUC = 0.748) and ICDP (AUC = 0.612) for metastatic LN discrimination. Clinical relevance Node-RADS is a standardized and reproducible criterion that can be applied in dual-energy CT scenarios to effectively identify regional lymph node metastasis in resectable gastric cancer.

PMID:
42967258
Bibliographic data and abstract were imported from PubMed on 01 Nov 2026.

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