Preoperative diagnosis of lymph node metastases in gastric cancer by magnetic resonance imaging with ferumoxtran-10

被引：73

作者：

Tatsumi Y. ^{[1
]}

Tanigawa N. ^{[1
]}

Nishimura H. ^{[1
]}

Nomura E. ^{[1
]}

Mabuchi H. ^{[1
]}

Matsuki M. ^{[2
]}

Narabayashi I. ^{[2
]}

机构：

[1] Department of General and Gastroenterological Surgery, Osaka Medical College, Takatsuki, Osaka 569-8686

[2] Department of Radiology, Osaka Medical College, Osaka

来源：

Gastric Cancer | 2006年 / 9卷 / 2期

关键词：

Ferumoxtran-10; Gastric cancer; Lymph node metastasis; Lymphadenectomy; Magnetic resonance (MR); Staging;

D O I：

10.1007/s10120-006-0365-8

中图分类号：

学科分类号：

摘要：

Background. Knowledge regarding the presence and location of lymph node metastasis in gastric cancer is essential in deciding on the operative approach. Lymph node metastases have been diagnosed with imaging tests such as computed tomography (CT) and ultrasonography (US); however, the accuracy of such diagnoses, based on size and shape criteria, has not been adequate. Ferumoxtran-10 (Combidex; Advanced Magnetics) is a lymphotropic contrast agent for magnetic resonance imaging (MRI) whose efficacy for the detection of metastatic lymph nodes in various cancers has been reported by several investigators; however, its efficacy for this purpose has not been reported for gastric cancer. We investigated the efficacy of ferumoxtran-10-enhanced MRI for the diagnosis of metastases to lymph nodes in gastric cancer. Methods. Seventeen consecutive patients who were diagnosed with a nonearly stage of gastric cancer were enrolled in the study. All the patients were examined by MRI (Signa Horizon 1.5 T; GE Medical; T2*-weighted images) before and 24 h after the intravenous administration of ultrasmall particles of superparamagnetic iron oxide - ferumoxtran-10 (2.6 mg Fe/kg of body weight) - and the presence or absence of metastasis was determined from the enhancement patterns. The imaging results were compared with the corresponding histopathological findings following surgery. Results. Of 781 lymph nodes dissected during surgery, the imaging results of 194 nodes could be correlated with their histopathological findings. Fifty-nine lymph nodes from 11 patients had histopathological metastases. In nonaffected normal lymph nodes, we observed dark signal intensity on MRI caused by the diffuse uptake of the contrast medium by macrophages resident in the lymph nodes, which phagocytose the iron oxide particles of ferumoxtran-10. The number of phagocytic macrophages was decreased in metastatic lymph nodes, and they showed various patterns of decreased uptake of ferumoxtran-10. Three enhancement patterns were observed in lymph nodes: (A) lymph nodes with overall dark signal intensity due to the diffuse uptake of ferumoxtran-10; (B) lymph nodes with partial high signal intensity due to partial uptake; and (C) no blackening of lymph nodes due to no uptake of ferumoxtran-10. Patterns (B) and (C) were defined as metastatic. The sensitivity, specificity, positive predictive value, negative predictive value, and overall predictive accuracy of postcontrast MRI were 100% (59/59), 92.6% (125/135), 85.5% (59/69), 100% (125/125), and 94.8% (184/194), respectively. These parameters for predictive accuracy were much superior to these parameters previously evaluated by CT or US. Nodes in the retroperitoneal and paraaortic regions were more readily identified and diagnosed on the MR images than those in the perigastric region. Conclusion. The present study confirmed that ferumoxtran-10-enhanced MRI is useful in the diagnosis of metastatic lymph nodes and that the use of this modality will be helpful in treatment decision-making for gastric cancer patients. © 2006 by International and Japanese Gastric Cancer Associations.

引用

页码：120 / 128

页数：8

共 28 条

[1] Kodama Y., Sugimachi K., Soejima K., Matsusaka T., Inokuchi K., Evaluation of extensive lymph node dissection for carcinoma of the stomach, World J Surg, 5, pp. 241-8, (1981)
[2] Hartgrink H.H., Van De Velde C.J., Putter H., Bonenkamp J.J., Klein Kranenbarg E., Songun I., Et al., Extended lymph node dissection for gastric cancer: Who may benefit? Final results of the randomized Dutch Gastric Cancer Group trial, J Clin Oncol, 22, pp. 2069-77, (2004)
[3] Fukuya T., Honda H., Hayashi T., Kaneko K., Tateshi Y., Ro T., Et al., Lymph-node metastases: Efficacy for detection with Helical CT in patients with gastric cancer, Radiology, 197, pp. 705-11, (1995)
[4] Ogawa K., Hirai M., Katsune T., Miura K., Wakasugi S., Watanabe T., Et al., Diagnosing ability of CT on periaortic lymph node metastasis of gastric cancer, J Jpn Clin Surg Soc, 55, pp. 843-7, (1994)
[5] Nomura E., Okajima K., Isozaki H., Nakata E., Takeda Y., Ichinona T., Et al., Studies of the metastatic lymph node and its images on computed tomography (CT) in gastric cancer, J Jpn Soc Clin Surg, 57, pp. 782-7, (1996)
[6] Nakajima T., Gastric cancer treatment guidelines in Japan, Gastric Cancer, 5, pp. 1-5, (2002)
[7] Kitagawa Y., Fujii H., Mukai M., Kubota T., Otani Y., Kitajima M., Radio-guided sentinel node detection for gastric cancer, Br J Surg, 89, pp. 604-8, (2002)
[8] Miwa K., Kinami S., Taniguchi K., Fushida S., Fujimura T., Nonomura A., Mapping sentinel nodes in patients with early-stage gastric carcinoma, Br J Surg, 90, pp. 178-82, (2003)
[9] Isozaki H., Kimura T., Tanaka N., Satoh K., Matsumoto S., Ninomiya M., An assessment of the feasibility of sentinel lymph node-guided surgery for gastric cancer, Gastric Cancer, 7, pp. 149-53, (2004)
[10] Weissleder R., Elizondo G., Wittenberg J., Rabito C.A., Bengele H.H., Josephson L., Ultrasmall superparamagnetic iron oxide: Characterization of a new class of contrast agents for MR imaging, Radiology, 175, pp. 489-93, (1990)

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