前列腺癌：利用超顺磁性氧化铁增强磁共振成像检测常规手术区域外的淋巴结转移
Prostate cancer: detection of lymph node metastases outside the routine surgical area with ferumoxtran-10-enhanced MR imaging.
作者信息
Heesakkers Roel A M, Jager Gerrit J, Hövels Anke M, de Hoop Bartjan, van den Bosch Harrie C M, Raat Frank, Witjes J Alfred, Mulders Peter F A, van der Kaa Christina Hulsbergen, Barentsz Jelle O
机构信息
Department of Radiology, University Medical Center Nijmegen, Geert Grooteplein zuid 10, NL 650 HB Nijmegen, the Netherlands.
出版信息
Radiology. 2009 May;251(2):408-14. doi: 10.1148/radiol.2512071018.
PURPOSE
To prospectively evaluate the feasibility of magnetic resonance (MR) imaging with ferumoxtran-10 in patients with prostate cancer to depict lymph node metastases outside the routine pelvic lymph node dissection (PLND) area.
MATERIALS AND METHODS
The study was approved by the institutional review boards at all four hospitals; patients provided written informed consent. Two hundred ninety-six consecutive men (mean age, 67 years; range, 47-83 years) with prostate cancer and an intermediate-to-high risk for nodal metastases (prostate-specific antigen level >10 ng/mL, Gleason score >6, or stage T3 disease) were enrolled. MR lymphography of the pelvis was performed 24 hours after intravenous drip infusion of ferumoxtran-10. Positive nodes at MR lymphography were indicated to be inside or outside the routine dissection area (RDA). On the basis of MR lymphography computed tomographic (CT)-guided biopsy, routine PLND, or MR imaging-guided minimal extended PLND was performed.
RESULTS
MR lymphography findings were positive in 58 patients. Of these, 44 had histopathologic confirmation of lymph node metastases. In 18 of 44 patients (41%), MR lymphography findings showed nodes exclusively outside the RDA, which were confirmed with MR lymphography-guided extended PLND (n = 13) and CT-guided biopsy (n = 5). In another 18 patients (41%), positive nodes were located both inside and outside the RDA at MR lymphography. In these 18 patients, routine PLND was used to confirm the nodes inside the RDA (n = 11); CT-guided biopsy was used to confirm nodes outside the RDA (n = 7). In the remaining eight patients, MR lymphography findings showed only nodes inside the RDA, which was confirmed with PLND (n = 5) and CT-guided biopsy (n = 3). In 14 of the 58 patients (24%), there was no histologic confirmation.
CONCLUSION
In 41% of patients with prostate cancer, nodal metastases outside the area of routine PLND were detected by using MR imaging with ferumoxtran-10.
目的
前瞻性评估钆喷酸葡胺增强磁共振成像（MR）对前列腺癌患者描绘常规盆腔淋巴结清扫（PLND）区域外淋巴结转移的可行性。
材料与方法
本研究经四家医院的机构审查委员会批准；患者提供了书面知情同意书。连续纳入296例前列腺癌患者（平均年龄67岁；范围47 - 83岁），这些患者有中到高的淋巴结转移风险（前列腺特异性抗原水平>10 ng/mL、Gleason评分>6或T3期疾病）。静脉滴注钆喷酸葡胺10后24小时进行盆腔MR淋巴造影。MR淋巴造影显示的阳性淋巴结被标记为在常规清扫区域（RDA）内或外。基于MR淋巴造影结果，进行CT引导下活检、常规PLND或MR成像引导下的最小范围扩大PLND。
结果
58例患者MR淋巴造影结果为阳性。其中，44例有淋巴结转移的组织病理学证实。在44例患者中的18例（41%），MR淋巴造影结果显示淋巴结仅在RDA外，通过MR淋巴造影引导下的扩大PLND（n = 13）和CT引导下活检（n = 5）得到证实。在另外18例患者（41%）中，MR淋巴造影时阳性淋巴结位于RDA内外。在这18例患者中，常规PLND用于证实RDA内的淋巴结（n = 11）；CT引导下活检用于证实RDA外的淋巴结（n = 7）。在其余8例患者中，MR淋巴造影结果仅显示RDA内的淋巴结，通过PLND（n = 5）和CT引导下活检（n = 3）得到证实。在58例患者中的14例（24%），没有组织学证实。
结论
在41%的前列腺癌患者中，使用钆喷酸葡胺增强MR成像检测到了常规PLND区域外的淋巴结转移。
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