Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA.
Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Eur Radiol. 2020 Mar;30(3):1790-1803. doi: 10.1007/s00330-019-06569-y. Epub 2019 Dec 16.
We compared the value of ferumoxytol (FMX)- and gadolinium (Gd)-enhanced MRI for assessment of sarcomas in paediatric/adolescent patients and hypothesised that tumour size and morphological features can be equally well assessed with both protocols.
We conducted a retrospective study of paediatric/adolescent patients with newly diagnosed bone or soft tissue sarcomas and both pre-treatment FMX- and Gd-MRI scans, which were maximal 4 weeks apart. Both protocols included T1- and T2-weighted sequences. One reader assessed tumour volumes, signal-to-noise ratios (SNR) of the primary tumour and adjacent tissues and contrast-to-noise ratios (CNR) of FMX- and Gd-MRI scans. Additionally, four readers scored FMX- and Gd-MRI scans according to 15 diagnostic parameters, using a Likert scale. The results were pooled across readers and compared between FMX- and Gd-MRI scans. Statistical methods included multivariate analyses with different models.
Twenty-two patients met inclusion criteria (16 males, 6 females; mean age 15.3 ± 5.0). Tumour volume was not significantly different on T1-LAVA (p = 0.721), T1-SE (p = 0.290) and T2-FSE (p = 0.609) sequences. Compared to Gd-MRI, FMX-MRI demonstrated significantly lower tumour SNR on T1-LAVA (p < 0.001), equal tumour SNR on T1-SE (p = 0.104) and T2-FSE (p = 0.305), significantly higher tumour-to-marrow CNR (p < 0.001) on T2-FSE as well as significantly higher tumour-to-liver (p = 0.021) and tumour-to-vessel (p = 0.003) CNR on T1-LAVA images. Peritumoural and marrow oedema enhanced significantly more on Gd-MRI compared to FMX-MRI (p < 0.001/p = 0.002, respectively). Tumour thrombi and neurovascular bundle involvement were assessed with a significantly higher confidence on FMX-MRI (both p < 0.001).
FMX-MRI provides equal assessment of the extent of bone and soft tissue sarcomas compared to Gd-MRI with improved tumour delineation and improved evaluation of neurovascular involvement and tumour thrombi. Therefore, FMX-MRI is a possible alternative to Gd-MRI for tumour staging in paediatric/adolescent sarcoma patients.
• Ferumoxytol can be used as an alterative to gadolinium chelates for MRI staging ofpaediatric sarcomas. • Ferumoxytol-enhanced MRI provides equal assessment of tumour size and other diagnostic parameters compared to gadolinium chelate-enhanced MRI. • Ferumoxytol-enhanced MRI provides improved delineation of sarcomas from bone marrow, liver and vessels compared to gadolinium chelate-enhanced MRI.
我们比较了超顺磁氧化铁（FMX）和钆（Gd）增强 MRI 在评估儿科/青少年患者肉瘤中的价值，并假设两种方案都可以同样好地评估肿瘤大小和形态特征。
我们对新诊断为骨或软组织肉瘤的儿科/青少年患者进行了回顾性研究，这些患者均在治疗前接受了 FMX 和 Gd-MRI 扫描，两次扫描之间的时间间隔最长为 4 周。两种方案均包括 T1-和 T2 加权序列。一位读者评估了肿瘤体积、原发肿瘤和相邻组织的信噪比（SNR）以及 FMX 和 Gd-MRI 扫描的对比噪声比（CNR）。此外，四位读者使用李克特量表根据 15 个诊断参数对 FMX 和 Gd-MRI 扫描进行评分。结果在读者之间进行汇总，并在 FMX 和 Gd-MRI 扫描之间进行比较。统计方法包括不同模型的多变量分析。
22 名患者符合纳入标准（男性 16 名，女性 6 名；平均年龄 15.3±5.0 岁）。T1-LAVA（p=0.721）、T1-SE（p=0.290）和 T2-FSE（p=0.609）序列上的肿瘤体积无显著差异。与 Gd-MRI 相比，FMX-MRI 在 T1-LAVA（p<0.001）、T1-SE（p=0.104）和 T2-FSE（p=0.305）上的肿瘤 SNR 显著降低，在 T2-FSE 上的肿瘤与骨髓 SNR 显著升高（p<0.001），在 T1-LAVA 上的肿瘤与肝脏（p=0.021）和肿瘤与血管（p=0.003）CNR 也显著升高。与 FMX-MRI 相比，Gd-MRI 增强的肿瘤周围和骨髓水肿明显更多（均 p<0.001/p=0.002）。肿瘤血栓和神经血管束受累在 FMX-MRI 上的评估具有更高的置信度（均 p<0.001）。
FMX-MRI 在评估骨和软组织肉瘤的范围方面与 Gd-MRI 相当，但肿瘤轮廓更好，神经血管受累和肿瘤血栓的评估也更好。因此，FMX-MRI 可能是儿科/青少年肉瘤患者肿瘤分期的 Gd-MRI 的替代方法。
• 超顺磁氧化铁可作为钆螯合物的替代品，用于儿科肉瘤的 MRI 分期。• FMX 增强 MRI 与 Gd 增强 MRI 相比，在评估肿瘤大小和其他诊断参数方面具有同等效果。• FMX 增强 MRI 与 Gd 增强 MRI 相比，能更好地显示肿瘤与骨髓、肝脏和血管的关系。
