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使用超小型超顺磁性氧化铁对原发性腹部和盆腔恶性肿瘤患者进行磁共振淋巴管造影:影像学与病理对照

MR lymphangiography using ultrasmall superparamagnetic iron oxide in patients with primary abdominal and pelvic malignancies: radiographic-pathologic correlation.

作者信息

Harisinghani M G, Saini S, Weissleder R, Hahn P F, Yantiss R K, Tempany C, Wood B J, Mueller P R

机构信息

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.

出版信息

AJR Am J Roentgenol. 1999 May;172(5):1347-51. doi: 10.2214/ajr.172.5.10227514.

Abstract

OBJECTIVE

The purpose of this study was to administer ultrasmall superparamagnetic iron oxide (USPIO) and compare changes in signal intensity of lymph nodes in patients with primary abdominal and pelvic malignancies. Also, we correlated radiographic with pathologic findings.

SUBJECTS AND METHODS

Nineteen patients with proven primary abdominal or pelvic cancer (prostatic [n = 10]; colonic [n = 5]; endometrial [n = 1]; Merkel cell tumor [n = 1]; lymphoma [n = 1]; seminoma [n = 1]) were enrolled as part of our phase II and phase III clinical trials. In these patients, 49 lymph nodes (mean size, 1.4 cm) revealed on CT or MR imaging were evaluated on T1-weighted spin-echo, T2-weighted fast spin-echo, and T2*-weighted gradient-echo MR imaging at 1.5 T 24-36 hr after IV administration of USPIO. Quantitative analyses used measurements of unenhanced and enhanced region-of-interest values in lymph nodes. Qualitative assessment used subjective evaluation and classification of changes in signal intensity. All patients underwent lymph node biopsy or surgical dissection followed by histopathologic correlation.

RESULTS

Of the 49 lymph nodes that were evaluated, 20 were benign and 29 were malignant. A decrease in nodal signal intensity on enhanced T2-weighted and T2*-weighted gradient-echo images was seen in 20 benign lymph nodes and two malignant lymph nodes. No appreciable signal change was noted in 27 of the 29 malignant lymph nodes. The mean signal intensity on fast spin-echo T2-weighted images for benign lymph nodes changed from 186.48 (unenhanced) to 73.66 (enhanced). Conversely, mean signal intensity for malignant lymph nodes was relatively unchanged from 191.17 (unenhanced) to 183.18 (enhanced).

CONCLUSION

USPIO appears to be a useful MR contrast agent for characterizing benign and malignant lymph nodes based on the enhancement criteria evaluated in our study.

摘要

目的

本研究的目的是给予超小型超顺磁性氧化铁(USPIO),并比较原发性腹部和盆腔恶性肿瘤患者淋巴结信号强度的变化。此外,我们还将影像学结果与病理结果进行了关联。

受试者与方法

19例经证实患有原发性腹部或盆腔癌症的患者(前列腺癌[n = 10];结肠癌[n = 5];子宫内膜癌[n = 1];默克尔细胞瘤[n = 1];淋巴瘤[n = 1];精原细胞瘤[n = 1])作为我们II期和III期临床试验的一部分入组。在这些患者中,对CT或MR成像显示的49个淋巴结(平均大小为1.4 cm)在静脉注射USPIO后24 - 36小时,于1.5 T场强下进行T1加权自旋回波、T2加权快速自旋回波和T2*加权梯度回波MR成像评估。定量分析采用测量淋巴结未增强和增强后的感兴趣区值。定性评估采用主观评价和信号强度变化分类。所有患者均接受淋巴结活检或手术切除,随后进行组织病理学关联分析。

结果

在评估的49个淋巴结中,20个为良性,29个为恶性。20个良性淋巴结和2个恶性淋巴结在增强的T2加权和T2*加权梯度回波图像上出现淋巴结信号强度降低。29个恶性淋巴结中有27个未观察到明显的信号变化。良性淋巴结在快速自旋回波T2加权图像上的平均信号强度从186.48(未增强)变为73.66(增强)。相反,恶性淋巴结的平均信号强度从191.17(未增强)到183.18(增强)相对未变。

结论

根据我们研究中评估的增强标准,USPIO似乎是一种用于鉴别良性和恶性淋巴结的有用MR对比剂。

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