From the Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (C.J.A.T., A.S.F., J.J.A.v.A., A.V., B.W.J.P., T.H., J.O.B., M.C.M., T.W.J.S.); Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (A.S.F.); Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany (S.O., H.H.Q., T.W.J.S.); High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany (S.O., H.H.Q.); and Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany (S.O.).
Invest Radiol. 2024 Jul 1;59(7):519-525. doi: 10.1097/RLI.0000000000001056. Epub 2023 Dec 29.
BACKGROUND: Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs. PURPOSE: The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa. MATERIALS AND METHODS: Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths. RESULTS: At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1-34 per patient) and 79 suspicious LNs on 3 T (range, 1-14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3-9.5 mm) and 2.8 mm for 3 T (1.7-10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes. CONCLUSIONS: In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients.
背景：准确检测前列腺癌（PCa）中的淋巴结（LN）转移是疾病分期的一个具有挑战性但至关重要的步骤。超顺磁氧化铁（USPIO）增强磁共振成像（MRI）可区分健康的 LN 和可疑存在转移的节点。当与超高磁场下的 MRI 结合使用时，可以利用前所未有的空间分辨率来可视化这些 LN。
目的：本研究旨在探索 USPIO 增强 MRI 在 7T 与 3T 之间在同一组 PCa 患者中检测小的可疑 LN 的效果。
材料与方法：20 例高危原发性或复发性疾病的 PCa 患者被转诊至我院进行 ferumoxtran-10 增强的 3T MRI 检查。征得同意后，他们在同一天接受了 7T MRI 检查。两名读者对两次检查的三维解剖和 T2*-加权图像进行了盲法评估，对可疑转移的 LN 进行注释。在患者内对 LN 的数量、大小和可疑程度（LoS）进行配对，并在两种场强之间进行比较。
结果：在 7T 时，两位读者的注释 LN 数量明显多于 3T（474 个与 284 个比 344 个与 162 个），17 例患者中有 116 个可疑 LN（范围为每个患者 1-34 个），7 例患者中有 79 个可疑 LN（范围为每个患者 1-14 个）。对于可疑 LN，7T 短轴直径中位数为 2.6mm（1.3-9.5mm），3T 为 2.8mm（1.7-10.4mm，P=0.05），LoS 组之间的注释 LN 短轴直径有很大重叠。在 7T 时，与 3T 相比，具有更小短轴的可疑 LN 明显更多（44%比 27%）。与 3T 相比，7T 增强 MRI 可提供更好的图像质量和结构勾画，并为可疑节点提供更高的 LoS 评分。
结论：在同一组 PCa 患者中，与 3T MRI 相比，7T 增强 USPIO MRI 检测到更多的小 LN。可疑 LN 通常非常小，LN 增大并不是存在转移的良好指示。7T 增强 MRI 的高空间分辨率可改善结构勾画和非常小的可疑 LN 的可视性，从而有可能扩大 PCa 患者盆部 LN 转移的体内检测极限。
Eur Radiol. 2019-6-14
Int J Radiat Oncol Biol Phys. 2012-3-13
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