MR Lymphangiography: Imaging Strategies to Optimize the Imaging of Lymph Nodes with Ferumoxtran-10

Harisinghani, Mukesh G.; Dixon, William J.; Saksena, Mansi; Brachtel, Elena F.; Blezek, Daniel J.; Dhawale, P.J.; Torabi, Maha; Hahn, Peter F.

doi:10.1148/rg.243035190

Cited by 86 publications

(57 citation statements)

References 28 publications

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“…We think that this problem may have been amplified in our study since a high-resolution technique using phased-array coils and/or three-dimensional techniques was not available at that time in our institution. This is especially true for the GRE T2-weighted sequences, which are more prone to suffer from magnetic susceptibility artifacts and possess lower spatial resolution (35).…”

Section: Discussionmentioning

confidence: 99%

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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Purpose:To determine the accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for nodal staging in patients with head and neck cancer. Materials and Methods:Twenty patients with carcinomas of the upper aerodigestive tract were prospectively enrolled. MRI was performed before and 24 -36 hours after intravenous infusion of an USPIO agent, ferumoxtran-10 (Sinerem; Guerbet, France; and Combidex; Advanced Magnetics) at a dose of 2.6 mg Fe/kg using T2-weighted spin-echo and gradient-echo sequences. Surgery was performed the same day or the day after the ferumoxtran-10 -enhanced MR examination. Based on MRI, selected nodes were surgically removed and directly correlated with pathology using hematoxylin-eosin (H&E) and Perls stainings.Results: A total of 63 nodes were studied; 36 were nonmetastatic, 25 metastatic, and two inflammatory. Ferumoxtran-10 -enhanced MRI allowed diagnosis of 24 metastatic and 30 nonmetastatic nodes, yielding a sensitivity of 96%, a specificity of 78.9%, a positive predictive value of 75%, and a negative predictive value of 96.8%, compared to 64%, 78.9%, 66.6%, and 76.9%, respectively, for nonenhanced MRI. Accuracy of ferumoxtran-10 -enhanced MRI was 85.7%. The gradient-echo T2-weighted sequence was the most accurate to detect signal loss in nonmetastatic nodes.Conclusion: USPIO-enhanced MRI is useful for nodal staging of patients with head and neck cancers. CROSS-SECTIONAL IMAGING plays an important role in the study of patients with head and neck squamous cell carcinomas, allowing detection of lymph nodes (LN) missed by physical examination, or demonstrating invasion of structures such as the skull base or the carotid arteries (1,2). Using these imaging modalities, the criteria for diagnosing metastatic nodes is mainly dimensional. Measurements include the minimum transaxial diameter, the maximum transaxial diameter or a ratio between the maximum longitudinal and the maximum axial diameters (3-7). Other parameters, such as morphological criteria or the pattern of enhancement, are regarded as less important in this setting. Nodal metastases in the head and neck are frequently smaller than 10 mm, sometimes even under 5 mm in diameter, a fact that accounts for the unsatisfactory performance of the current imaging techniques (8,9).MRI can be improved when using contrast agents suited for intravenous MR lymphography, such as the new ultrasmall superparamagnetic iron oxide (USPIO) particles, which are taken up by cells of the reticuloendothelial system of nonmetastatic LN (10 -15). As it has been shown in previous studies, iron oxide deposition leads to a decrease in the signal intensity (SI) in nonmetastatic nodes due to the T2 shortening effects, whereas metastatic nodes, devoid of macrophages, will not undergo SI changes when using T2-weighted sequences (11). The clinical use of this contrast agent is still under evaluation on phase III clinical trials (15)(16)(17)(18)(19)(20). Reports show promising results, with sensitivity and specificity value...

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Section: Discussionmentioning

confidence: 99%

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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“…It is well known that an insufficient dose of USPIO contrasting agent may result in false-positive findings during USPIO-enhanced MRI (20). Thus, based on several dosage studies for USPIO (21)(22)(23), 90 mmol Fe/kg (equal to 5 mg/kg Fe particles) was used in this study in order to avoid the influence by inadequate dosing.…”

Section: Discussionmentioning

confidence: 99%

“…T2-weighted imaging can be a good subjective indicator reflecting enhancement levels, but it does not reflect actual T2 relaxation time changes due to varying prescan parameters and system stability (34). The T2* value was tested but its signal diminished quickly to background levels at longer TEs, which prohibits accurate calculation of T2* or R2' values (35). Therefore, T2 values were used to calculate enhancement ratios in order to reflect the extent of changes and accounted for individual differences in the current study.…”

Section: Possible Value Of T2 Enhancement Ratiomentioning

confidence: 99%

Possible pathological basis for false diagnoses of lymph nodes by USPIO‐enhanced MRI in rabbits

Lei

Xue

et al. 2010

Magnetic Resonance Imaging

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Purpose: To determine the cause of misdiagnosis of lymph nodes in ultrasmall superparamagnetic iron oxide (USPIO) enhanced magnetic resonance imaging (MRI) using histological findings in rabbit tumor and inflammatory models.Materials and Methods: Thirty-six rabbits were randomly divided into inflammatory and tumor groups. MRI of the popliteal fossa was performed before and 24 hours after USPIO administration. Diagnoses of popliteal lymph nodes were evaluated based on dedicated criteria and were compared with histological and electronic microscopic findings.Results: There were 46 inflammatory and 26 metastatic lymph nodes. Sensitivity, specificity, and positive and negative predictive values of the diagnosis of nodal metastasis were 84.6%, 87.0%, 78.6%, and 90.9%, respectively. There were four false-negatives with subcapsular metastatic foci and six false-positives with predominant cortex and paracortex hyperplasia. Electron microscopy showed that in inflammatory nodes, cytophagic bubbles contain many USPIO particles, while in metastatic nodes they contained predominantly cellular residues.Conclusion: Diagnosis of lymph node malignancy is largely determined by the location and number of metastatic tumor cells. A profound understanding of the physiological role of macrophages in nodes with tumor burden will contribute to better diagnoses for clinical application. THE ACCURATE DETECTION of metastasis in lymph nodes is crucial for the prognosis and treatment plans of patients with malignant tumor. In the last few years ultrasmall superparamagnetic iron oxide (USPIO) agents have revolutionized lymph node imaging and have introduced functional imaging to conventional magnetic resonance imaging (MRI) (1-3). The nanoparticles are internalized by macrophages within the lymph nodes, and these intracellular iron-containing particles cause changes in magnetic properties detectable by MRI. These differences in signal intensity between normal and metastatic nodes can be easily detected visually (3). Several clinical studies have demonstrated that USPIO-enhanced MR is a particularly promising technique that improves the sensitivity and specificity of metastatic lymph node detection in pelvic, head and neck, chest, and other malignancies (2,4-13).Despite lots of promising results concerning USPIOenhanced MRI, there are still many important challenges to overcome, in which one problem is false-positive and false-negative results, affecting the accuracy of diagnosis (2,4-12). Harisinghani et al (2) reported that there were metastasis nodes that went undetected, and the false diagnosis was not negligible.In this work we established an animal model of inflammation and tumor in rabbit to thoroughly analyze the USPIO enhancement pattern of nodes. We used all types of images strictly paralleling the histologic microstructure of nodes in order to identify possible reasons for false diagnoses to refine the imaging diagnostic criteria of malignancy in lymph nodes. MATERIALS AND METHODS Animal ModelsThe experiments were performed using 36...

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“…Normal lymph nodes become dark in signal intensity after ferumoxtran-10 administration due to shortening of T2 and T2* relaxation times of water protons, whereas metastatic deposits within lymph nodes remain bright. 34,35 This agent has been used to evaluate lymph nodes in the setting of a wide variety of malignancies. For example, Deserno et al showed that ferumoxtran-10-enhanced MRI significantly improved nodal staging in those with bladder carcinoma by depicting metastases even in normal-sized lymph nodes, with accuracy, sensitivity, specificity, and positive and negative predictive values of 95%, 96%, 95%, 89%, and 98%, respectively.…”

Section: Functional Lymph Node Imagingmentioning

confidence: 99%

Functional Imaging of Cancer with Emphasis on Molecular Techniques

Torigian

Huang

Houseni

et al. 2007

CA: A Cancer Journal for Clinicians

127

105

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A multitude of noninvasive, quantitative, functional imaging techniques are currently in use to study tumor physiology, to probe tumor molecular processes, and to study tumor molecules and metabolites in vitro and in vivo using computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (US), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and optical imaging (OI). Such techniques can be used in conjunction with structural imaging techniques to detect, diagnose, characterize, or monitor tumors before and after therapeutic intervention. These can also be used to study tumor gene expression, to track cells and therapeutic drugs, to optimize individualized treatment planning for patients with tumors, and to foster new oncologic drug development.In this article, we review the rich variety of functional imaging techniques that are available for these purposes, which are becoming increasingly important for optimal individualized patient treatment in this day and age of "personalized medicine." (CA Cancer J Clin 2007;57:206-224.)

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MR Lymphangiography: Imaging Strategies to Optimize the Imaging of Lymph Nodes with Ferumoxtran-10

Cited by 86 publications

References 28 publications

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Possible pathological basis for false diagnoses of lymph nodes by USPIO‐enhanced MRI in rabbits

Functional Imaging of Cancer with Emphasis on Molecular Techniques

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