Axillary lymph node metastases in patients with breast carcinomas: Assessment with nonenhanced versus USPIO-enhanced MR imaging
Axillary lymph node metastases in patients with breast carcinomas: Assessment with nonenhanced versus USPIO-enhanced MR imaging
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DOI：
10.1148/radiol.2412050693
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发表时间：
2006-11-01
期刊：
影响因子：
19.7
通讯作者：
Helbich, Thomas H.
中科院分区：
文献类型：
--
作者：
Memarsadeghi, Mazda;Riedl, Christopher C.;Helbich, Thomas H.
目的：以组织病理学结果为参考标准，前瞻性评估非增强与超小超顺磁氧化铁（USPIO）增强磁共振（MR）成像对乳腺癌患者腋窝淋巴结转移的准确性。材料与方法：本研究经学校伦理委员会批准；获得书面知情同意。22名患有乳腺癌的女性（平均年龄60岁，范围40-79岁）接受了非增强和uspio增强（每公斤体重静脉注射2.6 mg铁）在内收和抬高的手臂位置进行了横向t1加权、横向和矢状T2加权和T2*加权的磁共振成像。两名经验丰富的放射科医生对组织病理学结果一无所知，分析了腋窝淋巴结的大小、形态特征和USPIO摄取情况。如果两位读者无法达成一致意见，第三位独立的放射科医生将起到决定性的作用。进行MR图像的视觉和定量分析。计算灵敏度、特异度和准确度值。为了评估USPIO给药后的效果，采用重复测量方差分析（混合模型）对MR序列的信噪比（SNR）变化进行统计分析。结果：磁共振非增强成像133例淋巴结，真阳性6例，真阴性99例，假阳性23例，假阴性5例。在uspio增强MR成像中，11个淋巴结被评为真阳性，120个为真阴性，2个为假阳性，无假阴性。在两个患者的两个转移淋巴结有一个以上的转移淋巴结，没有达成共识。uspio增强MR成像显示，每个节点的敏感性、特异性和准确性分别为100%、98%和98%。在uspio增强的MR成像中，每个患者没有转移性淋巴结被遗漏。所有序列在转移性和非转移性淋巴结的信噪比值降低方面存在显著的相互作用差异（P < 0.001至P = 0.022）。结论：uspio增强磁共振成像对乳腺癌患者腋窝淋巴结转移的评估有价值，优于非增强磁共振成像。
Purpose: To prospectively assess the accuracy of nonenhanced versus ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance (MR) imaging for depiction of axillary lymph node metastases in patients with breast carcinoma, with histopathologic findings as reference standard.Materials and Methods: The study was approved by the university ethics committee; written informed consent was obtained. Twenty-two women (mean age, 60 years; range, 40-79 years) with breast carcinomas underwent nonenhanced and USPIO-enhanced (2.6 mg of iron per kilogram of body weight intravenously administered) transverse T1-weighted and transverse and sagittal T2-weighted and T2*-weighted MR imaging in adducted and elevated arm positions. Two experienced radiologists, blinded to the histopathologic findings, analyzed images of axillary lymph nodes with regard to size, morphologic features, and USPIO uptake. A third independent radiologist served as a tiebreaker if consensus between two readers could not be reached. Visual and quantitative analyses of MR images were performed. Sensitivity, specificity, and accuracy values were calculated. To assess the effect of USPIO after administration, signal-to-noise ratio (SNR) changes were statistically analyzed with repeated-measurements analysis of variance (mixed model) for MR sequences.Results: At nonenhanced MR imaging, of 133 lymph nodes, six were rated as true-positive, 99 as true-negative, 23 as false-positive, and five as false-negative. At USPIO-enhanced MR imaging, 11 lymph nodes were rated as true-positive, 120 as true-negative, two as false-positive, and none as false-negative. In two metastatic lymph nodes in two patients with more than one metastatic lymph node, a consensus was not reached. USPIO-enhanced MR imaging revealed a node-by-node sensitivity, specificity, and accuracy of 100%, 98%, and 98%, respectively. At USPIO-enhanced MR imaging, no metastatic lymph nodes were missed on a patient-by-patient basis. Significant interactions indicating differences in the decrease of SNR values for metastatic and nonmetastatic lymph nodes were found for all sequences (P < .001 to P = .022).Conclusion: USPIO-enhanced MR imaging appears valuable for assessment of axillary lymph node metastases in patients with breast carcinomas and is superior to nonenhanced MR imaging.