Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging reliably detect pelvic lymph node metastases in normal-sized nodes of bladder and prostate cancer patients.
Combined ultrasmall superparamagnetic particles of iron oxide-enhanced and diffusion-weighted magnetic resonance imaging reliably detect pelvic lymph node metastases in normal-sized nodes of bladder and prostate cancer patients.
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结合氧化铁增强的超小超顺磁性颗粒和扩散加权磁共振成像，可以可靠地检测膀胱癌和前列腺癌患者正常大小淋巴结中的盆腔淋巴结转移。
DOI：
10.1016/j.eururo.2008.12.034
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发表时间：
2009
期刊：
影响因子：
23.4
通讯作者：
U. Studer
中科院分区：
文献类型：
--
作者：
H. Thoeny;M. Triantafyllou;F. Birkhaeuser;J. Froehlich;D. Tshering;T. Binser;A. Fleischmann;P. Vermathen;U. Studer
背景：使用常规成像对膀胱癌或前列腺癌进行淋巴结分期是有限的。较新的方法，如超小超顺磁性氧化铁颗粒（USPIO）和弥散加权磁共振成像（DW-MRI）的诊断准确性不一致，难以解释。目的：评估USPIO和DW-MRI联合（USPIO-DW-MRI）是否可改善膀胱癌和/或前列腺癌患者正常大小淋巴结的分期。设计、地点和参与者：2008年5月至10月，21例膀胱癌和/或前列腺癌患者连续入选。1例患者因DW-MRI检测到骨转移而被排除，随后免于手术。干预措施：术前患者在给予亲淋巴USPIO之前和之后使用常规MRI序列结合DW-MRI进行3-T MRI。手术包括扩大盆腔淋巴结清扫术和原发肿瘤切除术。测量：评价了“新”组合USPIO-DW-MRI方法与“经典”阅读方法的诊断准确性，评价了无DW-MRI和有DW-MRI与组织病理学的USPIO图像。记录每例患者两种阅读方法的持续时间。结果和局限性：对于经典的阅读方法，每个患者每个骨盆侧（两名阅片者）的诊断准确性如下：灵敏度，80%，71%;特异性，87%，94%;阳性预测值（PPV），67%，71%;阴性预测值（NPV），93%，94%;准确性，90%，90%。中位阅读时间为80分钟（范围：45- 180分钟）。附加DW-MRI进一步提高了经典阅读法的诊断准确性。新的阅读方法（USPIO-DW-MRI;三名独立的盲法阅片员）得出了相似的准确性（敏感性，80%，60%，80%;特异性，93%，80%，87%;准确性，90%，75%，85%; NPV，93%，86%，93%; PPV，80%，50%，67%），中位阅读时间较短，为13 min（范围：2- 90 min; p=1.1×10−18）。每例患者和每侧骨盆的3名阅片者之间的观察者间一致性的κ值分别为0.75和0.84。在2例患者中，所有影像学检查均漏诊了1个微转移灶（1.0×0.2mm; 0.7×0.4mm）。结论：USPIO-DW-MRI是检测盆腔淋巴结转移的一种快速准确的方法，即使在膀胱癌或前列腺癌患者的正常大小的淋巴结中也是如此。
BACKGROUND: Lymph node staging of bladder or prostate cancer using conventional imaging is limited. Newer approaches such as ultrasmall superparamagnetic particles of iron oxide (USPIO) and diffusion-weighted magnetic resonance imaging (DW-MRI) have inconsistent diagnostic accuracy and are difficult to interpret. OBJECTIVE: To assess whether combined USPIO and DW-MRI (USPIO–DW-MRI) improves staging of normal-sized lymph nodes in bladder and/or prostate cancer patients. DESIGN, SETTING, AND PARTICIPANTS: Twenty-one consecutive patients with bladder and/or prostate cancer were enrolled between May and October 2008. One patient was excluded secondary to bone metastases detected on DW-MRI with subsequent abstention from surgery. INTERVENTION: Patients preoperatively underwent 3-T MRI before and after administration of lymphotropic USPIO using conventional MRI sequences combined with DW-MRI. Surgery consisted of extended pelvic lymphadenectomy and resection of primary tumors. MEASUREMENTS: Diagnostic accuracies of the “new” combined USPIO–DW-MRI approach compared with the “classic” reading method evaluating USPIO images without and with DW-MRI versus histopathology were evaluated. Duration of the two reading methods was noted for each patient. RESULTS AND LIMITATIONS: For the classic reading method, diagnostic accuracy per patient per pelvic side (two readers) was as follows: sensitivity, 80%, 71%; specificity, 87%, 94%; positive predictive value (PPV), 67%, 71%; negative predictive value (NPV), 93%, 94%; and accuracy, 90%, 90%. Median reading time was 80min (range: 45–180min). Additional DW-MRI further improved the diagnostic accuracy of the classic reading method. The new reading method (USPIO–DW-MRI; three independent blinded readers) yielded similar accuracies (sensitivity, 80%, 60%, 80%; specificity, 93%, 80%, 87%; accuracy, 90%, 75%, 85%; NPV, 93%, 86%, 93%; PPV, 80%, 50%, 67%) in a shorter median reading time of 13min (range: 2–90min; p=1.1×10−18). Interobserver agreement between the three readers per patient and per pelvic side had κ values of 0.75 and 0.84, respectively. In two patients, one micrometastasis each (1.0×0.2mm; 0.7×0.4mm) was missed in all imaging studies. CONCLUSIONS: USPIO–DW-MRI is a fast and accurate method for detecting pelvic lymph node metastases, even in normal-sized nodes of bladder or prostate cancer patients.
影响因子：
158.5
作者：
Harisinghani, MG;Barentsz, J;Weissleder, R
通讯作者：
Weissleder, R
影响因子：
19.7
作者：
WEISSLEDER, R;ELIZONDO, G;BRADY, TJ
通讯作者：
BRADY, TJ