Rossi Federica, Körner Maximilian, Suárez José, Carozzi Gregorio, Meier Valeria S, Roos Malgorzata, Rohrer Bley Carla
Centro Oncologico Veterinario and Clinica Veterinaria dell'Orologio, Sasso Marconi (BO), I-40037, Italy.
Division of Radiation Oncology, University of Zurich, Zurich, CH-8057, Switzerland.
Vet Radiol Ultrasound. 2018 Mar;59(2):155-162. doi: 10.1111/vru.12569. Epub 2017 Oct 11.
Locoregional lymph nodes are routinely examined in order to define the spatial extent of neoplastic disease. As draining patterns of certain tumor types can be divergent from expected anatomical distribution, it is critical to sample the lymph nodes truly representing the draining area. The aim of this bicenter prospective pilot study was to describe the technique of computed tomographic (CT)-lymphography for primary draining lymph node mapping in tumor staging in dogs. Forty-five dogs with macro- or microscopic tumors in specified localizations were evaluated. Depending on body weight, 0.8-2 ml contrast agent (iohexol) was injected into four quadrants around the tumor, and CT-images were obtained at 1, 3, 6, 9, and 12 minutes post-injection. Attenuation of chosen regions of interest (Hounsfield units (HU)) and patterns of enhancement were assessed for 284 lymph nodes in the precontrast study with median HUs of 31.1 (Interquartile range (IQR) = 18.4) and for 275 in the intravenous postcontrast study with 104.3 HU (IQR = 31.2) (paired Wilcoxon test, P < 0.001). In the CT-lymphography study, 45 primary draining lymph nodes with a significantly higher median HU value of 348.5 (IQR = 591.4) (one-sample t-test, P < 0.001) were identified. Primary draining lymph nodes were found to be clearly visible after 1-3 minutes after local injection, often concurrent with a good visibility of the lymphatic vessel system. The herein described technique of peritumorally injected CT-contrast agent followed by subsequent CT-lymphography for primary draining lymph node mapping works well in a majority of cases in all investigated sites and warrants further validation for different tumor entities.
为了确定肿瘤性疾病的空间范围,通常会对局部区域淋巴结进行检查。由于某些肿瘤类型的引流模式可能与预期的解剖分布不同,对真正代表引流区域的淋巴结进行采样至关重要。这项双中心前瞻性试点研究的目的是描述计算机断层扫描(CT)淋巴造影技术,用于犬肿瘤分期中主要引流淋巴结的定位。对45只在特定部位有宏观或微观肿瘤的犬进行了评估。根据体重,将0.8 - 2毫升造影剂(碘海醇)注入肿瘤周围的四个象限,并在注射后1、3、6、9和12分钟获取CT图像。在造影前研究中,对284个淋巴结评估了感兴趣区域的衰减(亨氏单位(HU))和强化模式,中位数HU为31.1(四分位间距(IQR)= 18.4);在静脉注射造影剂后研究中,对275个淋巴结进行了评估,HU为104.3(IQR = 31.2)(配对Wilcoxon检验,P < 0.001)。在CT淋巴造影研究中,确定了45个主要引流淋巴结,其HU中位数显著更高,为348.5(IQR = 591.4)(单样本t检验,P < 0.001)。发现局部注射后1 - 3分钟主要引流淋巴结清晰可见,通常同时淋巴管系统也清晰可见。本文所述的在肿瘤周围注射CT造影剂随后进行CT淋巴造影以进行主要引流淋巴结定位的技术,在所有研究部位的大多数病例中效果良好,值得对不同肿瘤实体进行进一步验证。