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Gastrointestinal Imaging |
1 From the Departments of Academic Radiology (D.M.K., G.B., J.E.H.) and Medical Statistics (A.R.N.), Royal Marsden Hospital, Downs Rd, Sutton SM2 5PT, England; Departments of Pathology (L.T.) and Surgery (A.R., P.T.), Epsom General Hospital, England; and Department of Surgery, St Helier’s Hospital, St Helier, England (N.B.). From the 2002 RSNA scientific assembly. Received January 28, 2003; revision requested April 15; final revision received July 9; accepted August 6. Supported by a grant from the Royal College of Radiologists, United Kingdom. Address correspondence to D.M.K. (e-mail: dowmukoh@icr.ac.uk).
PURPOSE: To compare histopathologic findings with appearances of mesorectal lymph nodes at magnetic resonance (MR) imaging with ultrasmall particles of iron oxide (USPIO) in rectal cancer.
MATERIALS AND METHODS: Mesorectal lymph nodes in 12 patients with adenocarcinoma of the rectum were evaluated with USPIO and high-spatial-resolution MR imaging. Appearance and signal intensity of lymph nodes at T2- and T2*-weighted imaging were recorded before and after USPIO administration. Two radiologists visually assessed pattern of enhancement; interobserver agreement was tested with the 
statistic. After total mesorectal excision, MR imaging of surgical specimens was performed, and it enabled node-by-node correlation with histopathologic findings.
RESULTS: Appearances of 74 nodes at in vivo MR imaging were compared with histopathologic findings. Sixty-eight nodes were nonmalignant (34 were normal, 34 showed reactive changes); six nodes were malignant. Four patterns of USPIO uptake were demonstrated at T2*-weighted imaging: uniform low signal intensity, central low signal intensity, eccentric high signal intensity, and uniform high signal intensity. Two radiologists showed good interobserver agreement ( = 0.88, P < .01) in classification of nodes into these four categories. Sixty-five (96%) of 68 nonmalignant nodes showed uniform or central low-signal-intensity patterns; 16 (47%) of 34 reactive nodes showed central low-signal-intensity patterns. Compared with uniform low-signal-intensity pattern, central low-signal-intensity pattern was more commonly observed in reactive nodes (P < .01, 
2 test; positive predictive value, 67%; 95% CI: 47%, 87%). Eccentric and uniform high-signal-intensity patterns were observed in lymph nodes that contained metastases larger than 1 mm in diameter.
CONCLUSION: Mesorectal lymph nodes can be characterized by using USPIO and T2*-weighted MR imaging. Uniform and central low-signal-intensity patterns are features of nonmalignant nodes. Reactive nodes frequently show central low signal intensity at T2*-weighted imaging.
© RSNA, 2004
Index terms: Iron • Magnetic resonance (MR), contrast media, 757.12143 • Neoplasms, staging • Rectum, MR, 757.121411, 757.121412 • Rectum, neoplasms, 757.321
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