Ferumoxytol 增强 MRI 提高儿童和青年患者骨转移的检出率。
Improved Detection of Bone Metastases in Children and Young Adults with Ferumoxytol-enhanced MRI.
机构信息
From the Department of Radiology, Molecular Imaging Program at Stanford (A.R., L.B., A.J.T., K.E.H., J.S., H.E.D.L.), and Department of Radiology, Division of Pediatric Radiology (E.B.G., P.J.), Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Rd, Stanford, CA 94305-5654; and Quantitative Sciences Unit (R.L.) and Department of Pediatrics, Division of Hematology/Oncology (S.L.S., A.P., H.E.D.L.), Stanford University School of Medicine, Stanford, Calif.
出版信息
Radiol Imaging Cancer. 2023 Mar;5(2):e220080. doi: 10.1148/rycan.220080.
Purpose To evaluate if ferumoxytol can improve the detection of bone marrow metastases at diffusion-weighted (DW) MRI in pediatric and young adult patients with cancer. Materials and Methods In this secondary analysis of a prospective institutional review board-approved study (ClinicalTrials.gov identifier NCT01542879), 26 children and young adults (age range: 2-25 years; 18 males) underwent unenhanced or ferumoxytol-enhanced whole-body DW MRI between 2015 and 2020. Two reviewers determined the presence of bone marrow metastases using a Likert scale. One additional reviewer measured signal-to-noise ratios (SNRs) and tumor-to-bone marrow contrast. Fluorine 18 (F) fluorodeoxyglucose (FDG) PET and follow-up chest CT, abdominal and pelvic CT, and standard (non-ferumoxytol enhanced) MRI served as the reference standard. Results of different experimental groups were compared using generalized estimation equations, Wilcoxon rank sum test, and Wilcoxon signed rank test. Results The SNR of normal bone marrow was significantly lower at ferumoxytol-enhanced MRI compared with unenhanced MRI at baseline (21.380 ± 19.878 vs 102.621 ± 94.346, respectively; = .03) and after chemotherapy (20.026 ± 7.664 vs 54.110 ± 48.022, respectively; = .006). This led to an increased tumor-to-marrow contrast on ferumoxytol-enhanced MRI scans compared with unenhanced MRI scans at baseline (1397.474 ± 938.576 vs 665.364 ± 440.576, respectively; = .07) and after chemotherapy (1099.205 ± 864.604 vs 500.758 ± 439.975, respectively; = .007). Accordingly, the sensitivity and diagnostic accuracy for detecting bone marrow metastases were 96% (94 of 98) and 99% (293 of 297), respectively, with the use of ferumoxytol-enhanced MRI compared with 83% (106 of 127) and 95% (369 of 390) with the use of unenhanced MRI. Conclusion Use of ferumoxytol helped improve the detection of bone marrow metastases in children and young adults with cancer. Pediatrics, Molecular Imaging-Cancer, Molecular Imaging-Nanoparticles, MR-Diffusion Weighted Imaging, MR Imaging, Skeletal-Appendicular, Skeletal-Axial, Bone Marrow, Comparative Studies, Cancer Imaging, Ferumoxytol, USPIO © RSNA, 2023 ClinicalTrials.gov registration no. NCT01542879 See also the commentary by Holter-Chakrabarty and Glover in this issue.
目的 评估超顺磁性氧化铁对比剂（ferumoxytol）能否提高儿童和青年癌症患者弥散加权（DW）MRI 检测骨髓转移的能力。
材料与方法 本研究为前瞻性机构审查委员会批准的研究（ClinicalTrials.gov 标识符：NCT01542879）的二次分析，纳入 26 例年龄 2-25 岁（18 例男性）的儿童和青年患者，于 2015 年至 2020 年期间行未增强或 ferumoxytol 增强全身 DW MRI。两位观察者采用 Likert 量表评估骨髓转移的存在情况。另外一位观察者测量信号-噪声比（SNR）和肿瘤-骨髓对比度。氟-18（F）氟代脱氧葡萄糖（FDG）PET 及随访的胸部 CT、腹部和盆腔 CT 以及标准（非 ferumoxytol 增强）MRI 作为参考标准。采用广义估计方程、Wilcoxon 秩和检验和 Wilcoxon 符号秩检验比较不同实验组的结果。
结果 基线时 ferumoxytol 增强 MRI 检测正常骨髓的 SNR 明显低于未增强 MRI（分别为 21.380±19.878 和 102.621±94.346； =.03），化疗后 ferumoxytol 增强 MRI 检测正常骨髓的 SNR 也明显低于未增强 MRI（分别为 20.026±7.664 和 54.110±48.022； =.006）。因此，ferumoxytol 增强 MRI 检测骨髓转移的肿瘤-骨髓对比度明显高于未增强 MRI，基线时（分别为 1397.474±938.576 和 665.364±440.576； =.07），化疗后（分别为 1099.205±864.604 和 500.758±439.975； =.007）。因此，与未增强 MRI 相比，使用 ferumoxytol 增强 MRI 检测骨髓转移的灵敏度和诊断准确性分别为 96%（98 个中有 94 个）和 99%（297 个中有 293 个），而使用未增强 MRI 时分别为 83%（127 个中有 106 个）和 95%（390 个中有 369 个）。
结论 使用 ferumoxytol 有助于提高儿童和青年癌症患者骨髓转移的检出率。
儿科、分子成像-癌症、分子成像-纳米粒子、MR-DWI、MR 成像、骨骼-四肢、骨骼-脊柱、骨髓、对比研究、癌症成像、ferumoxytol、USPIO
RSNA，2023 年；ClinicalTrials.gov 注册号：NCT01542879
另见 Holter-Chakrabarty 和 Glover 在本期发表的述评。
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