Deserno Willem M L L G, Harisinghani Mukesh G, Taupitz Matthias, Jager Gerrit J, Witjes J Alfred, Mulders Peter F, Hulsbergen van de Kaa Christina A, Kaufmann D, Barentsz Jelle O
Department of Radiology, University Medical Center Sint Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands.
Radiology. 2004 Nov;233(2):449-56. doi: 10.1148/radiol.2332031111. Epub 2004 Sep 16.
To prospectively evaluate ferumoxtran-10-enhanced magnetic resonance (MR) imaging for nodal staging in patients with urinary bladder cancer.
Fifty-eight patients with proved bladder cancer were enrolled. Results of MR imaging performed before and after injection of ferumoxtran-10 were compared with histopathologic results in surgically removed lymph nodes. High-spatial-resolution three-dimensional T1-weighted magnetization-prepared rapid acquisition gradient-echo (voxel size, 1.4 x 1.4 x 1.4 mm) and T2*-weighted gradient-echo (voxel size, 0.8 x 0.8 x 3.0 mm) sequences were performed before and 24 hours after injection of ferumoxtran-10 (2.6 mg iron per kilogram of body weight). On precontrast images, lymph nodes were defined as malignant by using size and shape criteria (round node, >8 mm; oval, >10 mm axial diameter). On postcontrast images, nodes were considered benign if there was homogeneous decrease in signal intensity and malignant if decrease was absent or heterogeneous. Qualitative evaluation was performed on a node-to-node basis. Sensitivity, specificity, predictive values, and accuracy were evaluated with logistic regression analysis.
In 58 patients, 172 nodes imaged with use of ferumoxtran-10 were matched and correlated with results of node dissection. Of these, 122 were benign and 50 were malignant. With nodal size and shape criteria, accuracy, sensitivity, specificity, and positive and negative predictive values on precontrast images were 92%, 76%, 99%, 97%, and 91%, respectively; corresponding values on postcontrast images were 95%, 96%, 95%, 89%, and 98%. In the depiction of pelvic metastases, sensitivity and negative predictive value improved significantly at postcontrast compared with those at precontrast imaging, from 76% to 96% (P < .001) and from 91% to 98% (P < .01), respectively. At postcontrast imaging, metastases (4-9 mm) were prospectively found in 10 of 12 normal-sized nodes (<10 mm); these metastases were not detected on precontrast images. Postcontrast images also showed lymph nodes that were missed at pelvic node dissection in two patients.
Ferumoxtran-10-enhanced MR imaging significantly improves nodal staging in patients with bladder cancer by depicting metastases even in normal-sized lymph nodes.
前瞻性评估ferumoxtran - 10增强磁共振（MR）成像在膀胱癌患者淋巴结分期中的应用。
纳入58例经证实的膀胱癌患者。将注射ferumoxtran - 10前后进行的MR成像结果与手术切除淋巴结的组织病理学结果进行比较。在注射ferumoxtran - 10（2.6毫克铁/千克体重）前及24小时后，采用高空间分辨率三维T1加权磁化准备快速采集梯度回波序列（体素大小，1.4×1.4×1.4毫米）和T2 *加权梯度回波序列（体素大小，0.8×0.8×3.0毫米）。在对比前图像上，根据大小和形状标准（圆形淋巴结，>8毫米；椭圆形，轴向直径>10毫米）将淋巴结定义为恶性。在对比后图像上，如果信号强度均匀降低，则认为淋巴结为良性；如果信号强度无降低或不均匀降低，则认为淋巴结为恶性。对每个淋巴结进行定性评估。采用逻辑回归分析评估敏感性、特异性、预测值和准确性。
58例患者中，172个使用ferumoxtran - 10成像的淋巴结与淋巴结清扫结果匹配并相关。其中，122个为良性，50个为恶性。根据淋巴结大小和形状标准，对比前图像上的准确性、敏感性、特异性以及阳性和阴性预测值分别为92%、76%、99%、97%和91%；对比后图像上的相应值分别为95%、96%、95%、89%和98%。在盆腔转移灶的显示方面，与对比前成像相比，对比后成像的敏感性和阴性预测值显著提高，分别从76%提高到96%（P <.001）和从91%提高到98%（P <.01）。在对比后成像中，12个正常大小（<10毫米）的淋巴结中有10个前瞻性发现有转移灶（4 - 9毫米）；这些转移灶在对比前图像上未被检测到。对比后图像还显示了两名患者盆腔淋巴结清扫时遗漏的淋巴结。
Ferumoxtran - 10增强MR成像通过显示即使是正常大小淋巴结中的转移灶，显著改善了膀胱癌患者的淋巴结分期。
