You have accessJournal of UrologyBladder Cancer: Invasive/Metastatic Disease I1 Apr 20101642 USPIO-ENHANCED DIFFUSION-WEIGHTED MRI IMPROVES THE LYMPH NODE STAGING OF BLADDER OR PROSTATE CANCER Harriet C. Thoeny, Frédéric D. Birkhaeuser, Johannes M. Froehlich, Achim Fleischmann, Maria Triantafyllou, Tobias Binser, Peter Vermathen, and Urs E. Studer Harriet C. ThoenyHarriet C. Thoeny More articles by this author , Frédéric D. BirkhaeuserFrédéric D. Birkhaeuser More articles by this author , Johannes M. FroehlichJohannes M. Froehlich More articles by this author , Achim FleischmannAchim Fleischmann More articles by this author , Maria TriantafyllouMaria Triantafyllou More articles by this author , Tobias BinserTobias Binser More articles by this author , Peter VermathenPeter Vermathen More articles by this author , and Urs E. StuderUrs E. Studer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1444AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Preoperative detection of lymph node metastases is of outmost importance as it has been shown that resection of metastases in normal sized nodes increases long-term survival. Diffusion-weighted MRI (DW-MRI) after administration of USPIO allows combining cellular, functional and susceptibility effects. The hypothesis that DW-MRI with USPIO helps to increase the diagnostic confidence of normal sized lymph node staging in patients with bladder or prostate cancer was studied in a prospective clinical trial. METHODS Fifty-five patients (8w, 47m) with bladder (n=17), prostate (n=33) or both cancers (n=5) and with normal-sized lymph nodes on CT were examined twice on a 3T MR unit. Before and 24 to 36 hours after intravenous administration of USPIO (Sinerem®, Guerbet, France) morphological 3D T1-w and T2-w sequences (isotropic voxel size 0.75-1.0 mm3 respectively) were acquired. Moreover post contrast a coronal 3D VIBE and an axial DW-MRI sequence were measured. Image analysis was performed in consensus by 2-3 readers. Round hyperintense structures on high b-value images corresponding to lymph nodes on morphological images were considered malignant. Results were compared to histopathology. Diagnostic accuracies were calculated both on a per patient and a per lymph node level. Time of image analysis was recorded. RESULTS All patients underwent template lymphadenectomy with a total number of 2133 resected lymph nodes. Histopathology diagnosed 17/55 (31%) patients as positive and 38 patients (69%) as negative. USPIO-enhanced DW-MRI correctly diagnosed 11/17 (64%) patients as positive and 32/38 (84%) as negative. Six out of 17patients (35%) were false negative and another 6 patients were false positive. On a per patient level sensitivity was 65%, specificity was 84%, PPV 65%, NPV 85% and diagnostic accuracy 78%. On a lymph node level histology revealed 56/2133 lymph nodes as positive. 31/56 were correctly diagnosed as positive, whereas 25/ 56 were missed by imaging and 13 lymph nodes were false positive resulting in a sensitivity of 55%, specificity of 99%, PPV 70%, NPV 99% and diagnostic accuracy 98%. Image analysis using the combined USPIO enhanced DW-MRI lasted 6 min per patient (range 2-45 min). CONCLUSIONS USPIO in combination with DW-MRI seems to be a promising, accurate and fast new method to detect pelvic lymph node metastases even in normal sized nodes of patients with bladder and prostate cancer. Bern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e634-e635 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Harriet C. Thoeny More articles by this author Frédéric D. Birkhaeuser More articles by this author Johannes M. Froehlich More articles by this author Achim Fleischmann More articles by this author Maria Triantafyllou More articles by this author Tobias Binser More articles by this author Peter Vermathen More articles by this author Urs E. Studer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...