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Genitourinary Imaging |
1 From the Departments of Radiology (W.M.L.L.G.D., G.J.J., J.O.B.), Urology (J.A.W., P.F.M.), and Pathology (C.A.H.v.d.K.), University Medical Center Sint Radboud, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Radiology (M.G.H.) and Oncology (D.K.), Massachusetts General Hospital, Boston, Mass; and Department of Radiology, Charité Hospital Berlin, Germany (M.T.). Received July 15, 2003; revision requested September 18; final revision received February 24, 2004; accepted March 16. Address correspondence to W.M.L.L.G.D. (e-mail: w.deserno@rad.umcn.nl).
PURPOSE: To prospectively evaluate ferumoxtran-10–enhanced magnetic resonance (MR) imaging for nodal staging in patients with urinary bladder cancer.
MATERIALS AND METHODS: Fifty-eight patients with proved bladder cancer were enrolled. Results of MR imaging performed before and after injection of ferumoxtran-10 were compared with histopathologic results in surgically removed lymph nodes. High-spatial-resolution three-dimensional T1-weighted magnetization-prepared rapid acquisition gradient-echo (voxel size, 1.4 x 1.4 x 1.4 mm) and T2*-weighted gradient-echo (voxel size, 0.8 x 0.8 x 3.0 mm) sequences were performed before and 24 hours after injection of ferumoxtran-10 (2.6 mg iron per kilogram of body weight). On precontrast images, lymph nodes were defined as malignant by using size and shape criteria (round node, >8 mm; oval, >10 mm axial diameter). On postcontrast images, nodes were considered benign if there was homogeneous decrease in signal intensity and malignant if decrease was absent or heterogeneous. Qualitative evaluation was performed on a node-to-node basis. Sensitivity, specificity, predictive values, and accuracy were evaluated with logistic regression analysis.
RESULTS: In 58 patients, 172 nodes imaged with use of ferumoxtran-10 were matched and correlated with results of node dissection. Of these, 122 were benign and 50 were malignant. With nodal size and shape criteria, accuracy, sensitivity, specificity, and positive and negative predictive values on precontrast images were 92%, 76%, 99%, 97%, and 91%, respectively; corresponding values on postcontrast images were 95%, 96%, 95%, 89%, and 98%. In the depiction of pelvic metastases, sensitivity and negative predictive value improved significantly at postcontrast compared with those at precontrast imaging, from 76% to 96% (P < .001) and from 91% to 98% (P < .01), respectively. At postcontrast imaging, metastases (4–9 mm) were prospectively found in 10 of 12 normal-sized nodes (<10 mm); these metastases were not detected on precontrast images. Postcontrast images also showed lymph nodes that were missed at pelvic node dissection in two patients.
CONCLUSION: Ferumoxtran-10–enhanced MR imaging significantly improves nodal staging in patients with bladder cancer by depicting metastases even in normal-sized lymph nodes.
© RSNA, 2004
Index terms: Bladder neoplasms, metastases, 83.31, 83.33 • Bladder neoplasms, MR, 83.12141 • Iron • Magnetic resonance (MR), contrast media
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