Superparamagnetic Iron Oxide–enhanced MR Imaging of Head and Neck Lymph Nodes

Mack, Martin G.; Balzer, J. O.; Straub, Roland; Eichler, Katrin; Vogl, Thomas J.

doi:10.1148/radiol.2221010225

Cited by 159 publications

(72 citation statements)

References 29 publications

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“…USPIO particles have been developed with the knowledge that they are selectively taken by cells of the reticuloendothelial system present in nonmetastatic LN, with differences in enhancement reflecting the functional status of the nodes, allowing discrimination of benign from malignant ones (17,28). Although their use for human studies has been limited (9,10,(15)(16)(17)(18)(19)(20), they have showed encouraging results, with reported high sensitivity and specificity values (9,10,16,17,19,20). Recently, combined positron emission tomography (PET)/CT has been used successfully for staging of nodal disease in Figure 3.…”

Section: Discussionmentioning

confidence: 99%

“…Although the ferumoxtran-10 -enhanced SE PD/T2-weighted sequences allowed detection of all metastatic nodes, they were not able to demonstrate an unequivocal SI loss in a great proportion of nonmetastatic LN, resulting in a low specificity (55.3%). On the contrary, GRE T2-weighted images allowed easier detection of nonmetastatic LN due to a more pronounced SI loss after the administration of ferumoxtran-10, providing the best contrast between areas of nonenhancement and areas of intranodal iron deposits (10,17). This is related to magnetic suscepti- .…”

Section: Discussionmentioning

confidence: 99%

“…The clinical use of this contrast agent is still under evaluation on phase III clinical trials (15)(16)(17)(18)(19)(20). Reports show promising results, with sensitivity and specificity values ranging from 59% to 100% and 77% to 100%, respectively (9,10,16,17,19,20).The purpose of this study was to perform a direct comparison between MRI and pathological examination of selected LN in patients with head and neck cancer, determining the enhancement patterns of metastatic …”

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confidence: 99%

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USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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Purpose:To determine the accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for nodal staging in patients with head and neck cancer. Materials and Methods:Twenty patients with carcinomas of the upper aerodigestive tract were prospectively enrolled. MRI was performed before and 24 -36 hours after intravenous infusion of an USPIO agent, ferumoxtran-10 (Sinerem; Guerbet, France; and Combidex; Advanced Magnetics) at a dose of 2.6 mg Fe/kg using T2-weighted spin-echo and gradient-echo sequences. Surgery was performed the same day or the day after the ferumoxtran-10 -enhanced MR examination. Based on MRI, selected nodes were surgically removed and directly correlated with pathology using hematoxylin-eosin (H&E) and Perls stainings.Results: A total of 63 nodes were studied; 36 were nonmetastatic, 25 metastatic, and two inflammatory. Ferumoxtran-10 -enhanced MRI allowed diagnosis of 24 metastatic and 30 nonmetastatic nodes, yielding a sensitivity of 96%, a specificity of 78.9%, a positive predictive value of 75%, and a negative predictive value of 96.8%, compared to 64%, 78.9%, 66.6%, and 76.9%, respectively, for nonenhanced MRI. Accuracy of ferumoxtran-10 -enhanced MRI was 85.7%. The gradient-echo T2-weighted sequence was the most accurate to detect signal loss in nonmetastatic nodes.Conclusion: USPIO-enhanced MRI is useful for nodal staging of patients with head and neck cancers. CROSS-SECTIONAL IMAGING plays an important role in the study of patients with head and neck squamous cell carcinomas, allowing detection of lymph nodes (LN) missed by physical examination, or demonstrating invasion of structures such as the skull base or the carotid arteries (1,2). Using these imaging modalities, the criteria for diagnosing metastatic nodes is mainly dimensional. Measurements include the minimum transaxial diameter, the maximum transaxial diameter or a ratio between the maximum longitudinal and the maximum axial diameters (3-7). Other parameters, such as morphological criteria or the pattern of enhancement, are regarded as less important in this setting. Nodal metastases in the head and neck are frequently smaller than 10 mm, sometimes even under 5 mm in diameter, a fact that accounts for the unsatisfactory performance of the current imaging techniques (8,9).MRI can be improved when using contrast agents suited for intravenous MR lymphography, such as the new ultrasmall superparamagnetic iron oxide (USPIO) particles, which are taken up by cells of the reticuloendothelial system of nonmetastatic LN (10 -15). As it has been shown in previous studies, iron oxide deposition leads to a decrease in the signal intensity (SI) in nonmetastatic nodes due to the T2 shortening effects, whereas metastatic nodes, devoid of macrophages, will not undergo SI changes when using T2-weighted sequences (11). The clinical use of this contrast agent is still under evaluation on phase III clinical trials (15)(16)(17)(18)(19)(20). Reports show promising results, with sensitivity and specificity value...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Curvo-Semedo

Diniz

Miguéis

et al. 2006

Magnetic Resonance Imaging

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“…82,86,95,155 Specifically, the SPIO extravasate from the vasculature to the interstitial space where they are transported to the lymph nodes via the lymphatic vessels. The absence of SPIO in lymph nodes as determined by MR imaging has been shown to correlate with disturbances in lymph node flow or architecture due to the presence of metastases.…”

Section: Lymph Node Imagingmentioning

confidence: 99%

Superparamagnetic Iron Oxide Nanoparticle Probes for Molecular Imaging

et al. 2006

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Abstract-The field of molecular imaging has recently seen rapid advances in the development of novel contrast agents and the implementation of insightful approaches to monitor biological processes non-invasively. In particular, superparamagnetic iron oxide nanoparticles (SPIO) have demonstrated their utility as an important tool for enhancing magnetic resonance contrast, allowing researchers to monitor not only anatomical changes, but physiological and molecular changes as well. Applications have ranged from detecting inflammatory diseases via the accumulation of non-targeted SPIO in infiltrating macrophages to the specific identification of cell surface markers expressed on tumors. In this article, we attempt to illustrate the broad utility of SPIO in molecular imaging, including some of the recent developments, such as the transformation of SPIO into an activatable probe termed the magnetic relaxation switch.

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“…Also the introduction of lymph node specific contrast agents like ultrasmall particles iron oxide on magnetic resonance imaging (MRI) provides differentiation between benign and malignant lymph nodes in the head and neck and results are improving [11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma

et al. 2009

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Introduction The aim was to determine the diagnostic accuracy and additional value of diffusion-weighted imaging for detection of malignant lymph nodes in head and neck squamous cell carcinoma.Methods Two hundred nineteen lymph nodes, predominantly smaller than 10 mm (95.4%), in 16 consecutive patients were evaluated at 1.5 T. Lymph nodes were evaluated for maximum short axial diameter, morphological criteria, and apparent diffusion coefficient (ADC) values (b=0 and b=1,000 s/mm 2 ). Sensitivity, specificity, positive and negative predictive values as well as diagnostic odds ratios (DORs) and areas under the curves (AUCs) of ROC curves were calculated for the various magnetic resonance imaging (MRI) criteria individually and in combination. Histological examination of lymph nodes in the neck dissection specimen was the gold standard to determine malignant involvement. Results The optimal ADC threshold was 1.0×10 −3 mm 2 /s. Using this cutoff point, sensitivity and specificity were 92.3% and 83.9%, respectively. When used in combination with size and morphological criteria, ADC value <1.0× 10 −3 mm 2 /s was the strongest predictor of presence of metastasis (DOR=97.6). A model which added ADC values to the other MRI criteria performed significantly better than a model without ADC values: AUC=0.98 versus AUC=0.91 (p=0.036). Conclusion In this study, with predominantly small lymph nodes, the ADC criterion is the strongest independent predictor of presence of metastasis. The use of ADC values in combination with the other MRI criteria significantly improves the discrimination between malignant and benign lymph nodes.

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Superparamagnetic Iron Oxide–enhanced MR Imaging of Head and Neck Lymph Nodes

Abstract: SPIO-enhanced MR imaging has an important effect on planning the extent of surgery. On a patient basis, SPIO-enhanced MR images compared well with resected specimens.

Cited by 159 publications

References 29 publications

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

USPIO‐enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer

Superparamagnetic Iron Oxide Nanoparticle Probes for Molecular Imaging

Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma

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