Abstract
ObjectivesThe key to MR lymphography is suppression of T2* MR signal in normal lymph nodes, while retaining high signal in metastatic nodes. Our objective is to quantitatively compare the ability of ferumoxtran-10 and ferumoxytol to suppress the MR signal in normal pelvic lymph nodes.MethodsIn 2010, a set of consecutive patients who underwent intravenous MR Lymphography (MRL) were included. Signal suppression in normal lymph nodes in T2*-weighted images due to uptake of USPIO (Ultra-Small Superparamagnetic Particles of Iron Oxide) was quantified. Signal suppression by two USPIO contrast agents, ferumoxtran-10 and ferumoxytol was compared using Wilcoxon’s signed rank test.ResultsForty-four patients were included, of which all 44 had a ferumoxtran-10 MRL and 4 had additionally a ferumoxytol MRL. A total of 684 lymph nodes were identified in the images, of which 174 had been diagnosed as metastatic. USPIO-induced signal suppression in normal lymph nodes was significantly stronger in ferumoxtran-10 MRL than in ferumoxytol MRL (p < 0.005).ConclusionsT2* signal suppression in normal pelvic lymph nodes is significantly stronger with ferumoxtran-10 than with ferumoxytol, which may affect diagnostic accuracy.
Highlights
Prostate cancer (PCa) is the most common type of cancer and the second leading cause of cancer death in men (Siegel, Miller & Jemal, 2015)
This study retrospectively evaluated clinically obtained MR Lymphography (MRL) data
The results of this pilot study show, that relative signal intensity (SI) in normal lymph nodes was significantly higher in post-contrast ferumoxytol MRL than in ferumoxtran-10 MRL, both visually and quantitatively (p < 0.005)
Summary
Prostate cancer (PCa) is the most common type of cancer and the second leading cause of cancer death in men (Siegel, Miller & Jemal, 2015). The presence of lymph node metastases is a poor prognostic factor, reducing treatment options Conventional imaging modalities such as CT or MRI rely on size and shape criteria to detect metastatic lymph nodes, resulting in poor sensitivity and specificity (Hövels et al, 2008; Heesakkers et al, 2008). To select patients for PLND or elective nodal irradiation, various nomograms (Partin et al, 1993; Partin et al, 1997) and numerical formulae (Roach et al, 1994; Nguyen et al, 2009) are used to predict nodal involvement These do not provide information on the number, size, and location of metastatic nodes, which are important parameters for staging (Cheng et al, 2012). These do not provide information on the number, size, and location of metastatic nodes, which are important parameters for staging (Cheng et al, 2012). 11C-choline PET/CT has been shown to be more accurate than CT and MR (Schiavina et al, 2008), but has limited sensitivity in the substantial group of smaller lymph node metastases
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