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Tenbergen CJA, Fortuin AS, van Asten JJA, Veltien A, Philips BWJ, Hambrock T, Orzada S, Quick HH, Barentsz JO, Maas MC, Scheenen TWJ. The Potential of Iron Oxide Nanoparticle-Enhanced MRI at 7 T Compared With 3 T for Detecting Small Suspicious Lymph Nodes in Patients With Prostate Cancer. Invest Radiol 2023:00004424-990000000-00184. [PMID: 38157433 DOI: 10.1097/rli.0000000000001056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs. PURPOSE The aim of this study was to explore USPIO-enhanced MRI at 7 T in comparison to 3 T for the detection of small suspicious LNs in the same cohort of patients with PCa. MATERIALS AND METHODS Twenty PCa patients with high-risk primary or recurrent disease were referred to our hospital for an investigational USPIO-enhanced 3 T MRI examination with ferumoxtran-10. With consent, they underwent a 7 T MRI on the same day. Three-dimensional anatomical and T2*-weighted images of both examinations were evaluated blinded, with an interval, by 2 readers who annotated LNs suspicious for metastases. Number, size, and level of suspicion (LoS) of LNs were paired within patients and compared between field strengths. RESULTS At 7 T, both readers annotated significantly more LNs compared with 3 T (474 and 284 vs 344 and 162), with 116 suspicious LNs on 7 T (range, 1-34 per patient) and 79 suspicious LNs on 3 T (range, 1-14 per patient) in 17 patients. For suspicious LNs, the median short axis diameter was 2.6 mm on 7 T (1.3-9.5 mm) and 2.8 mm for 3 T (1.7-10.4 mm, P = 0.05), with large overlap in short axis of annotated LNs between LoS groups. At 7 T, significantly more suspicious LNs had a short axis <2.5 mm compared with 3 T (44% vs 27%). Magnetic resonance imaging at 7 T provided better image quality and structure delineation and a higher LoS score for suspicious nodes. CONCLUSIONS In the same cohort of patients with PCa, more and more small LNs were detected on 7 T USPIO-enhanced MRI compared with 3 T MRI. Suspicious LNs are generally very small, and increased nodal size was not a good indication of suspicion for the presence of metastases. The high spatial resolution of USPIO-enhanced MRI at 7 T improves structure delineation and the visibility of very small suspicious LNs, potentially expanding the in vivo detection limits of pelvic LN metastases in PCa patients.
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Affiliation(s)
- Carlijn J A Tenbergen
- From the Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands (C.J.A.T., A.S.F., J.J.A.v.A., A.V., B.W.J.P., T.H., J.O.B., M.C.M., T.W.J.S.); Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, the Netherlands (A.S.F.); Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany (S.O., H.H.Q., T.W.J.S.); High-Field and Hybrid MR Imaging, University Hospital Essen, Essen, Germany (S.O., H.H.Q.); and Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany (S.O.)
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Fortuin AS, Philips BWJ, van der Leest MMG, Ladd ME, Orzada S, Maas MC, Scheenen TWJ. Magnetic resonance imaging at ultra-high magnetic field strength: An in vivo assessment of number, size and distribution of pelvic lymph nodes. PLoS One 2020; 15:e0236884. [PMID: 32735614 PMCID: PMC7394386 DOI: 10.1371/journal.pone.0236884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 07/15/2020] [Indexed: 01/17/2023] Open
Abstract
Objective The definition of an in vivo nodal anatomical baseline is crucial for validation of representative lymph node dissections and accompanying pathology reports of pelvic cancers, as well as for assessing a potential therapeutic effect of extended lymph node dissections. Therefore the number, size and distribution of lymph nodes in the pelvis were assessed with high-resolution, large field-of-view, 7 Tesla (T) magnetic resonance imaging (MRI) with frequency-selective excitation. Materials and methods We used 7 T MRI for homogeneous pelvic imaging in 11 young healthy volunteers. Frequency-selective imaging of water and lipids was performed to detect nodal structures in the pelvis. Number and size of detected nodes was measured and size distribution per region was assessed. An average volunteer-normalized nodal size distribution was determined. Results In total, 564 lymph nodes were detected in six pelvic regions. Mean number was 51.3 with a wide range of 19–91 lymph nodes per volunteer. Mean diameter was 2.3 mm with a range of 1 to 7 mm. 69% Was 2 mm or smaller. The overall size distribution was very similar to the average volunteer-normalized nodal size distribution. Conclusions The amount of in vivo visible lymph nodes varies largely between subjects, whereas the normalized size distribution of nodes does not. The presence of many small lymph nodes (≤2mm) renders representative or complete removal of pelvic lymph nodes to be very difficult. 7T MRI may shift the in vivo detection limits of lymph node metastases in the future.
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Affiliation(s)
- Ansje S. Fortuin
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Bart W. J. Philips
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mark E. Ladd
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Stephan Orzada
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
| | - Marnix C. Maas
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W. J. Scheenen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, Essen, Germany
- * E-mail:
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Philips BWJ, Stijns RCH, Rietsch SHG, Brunheim S, Barentsz JO, Fortuin AS, Quick HH, Orzada S, Maas MC, Scheenen TWJ. USPIO-enhanced MRI of pelvic lymph nodes at 7-T: preliminary experience. Eur Radiol 2019; 29:6529-6538. [PMID: 31201525 PMCID: PMC6828641 DOI: 10.1007/s00330-019-06277-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 04/16/2019] [Accepted: 05/17/2019] [Indexed: 02/06/2023]
Abstract
Purpose To evaluate the technical feasibility of high-resolution USPIO-enhanced magnetic resonance imaging of pelvic lymph nodes (LNs) at ultrahigh magnetic field strength. Materials and methods The ethics review board approved this study and written informed consent was obtained from all patients. Three patients with rectal cancer and three selected patients with (recurrent) prostate cancer were examined at 7-T 24–36 h after intravenous ferumoxtran-10 administration; rectal cancer patients also received a 3-T MRI. Pelvic LN imaging was performed using the TIAMO technique in combination with water-selective multi-GRE imaging and lipid-selective GRE imaging with a spatial resolution of 0.66 × 0.66 × 0.66mm3. T2*-weighted images of the water-selective imaging were computed from the multi-GRE images at TE = 0, 8, and 14 ms and used for the assessment of USPIO uptake. Results High-resolution 7-T MR gradient-echo imaging was obtained robustly in all patients without suffering from RF-related signal voids. USPIO signal decay in LNs was visualized using computed TE imaging at TE = 8 ms and an R2* map derived from water-selective imaging. Anatomically, LNs were identified on a combined reading of computed TE = 0 ms images from water-selective scans and images from lipid-selective scans. A range of 3–48 LNs without USPIO signal decay was found per patient. These LNs showed high signal intensity on computed TE = 8 and 14 ms imaging and low R2* (corresponding to high T2*) values on the R2* map. Conclusion USPIO-enhanced MRI of the pelvis at 7-T is technically feasible and offers opportunities for detecting USPIO uptake in normal-sized LNs, due to its high intrinsic signal-to-noise ratio and spatial resolution. Key Points • USPIO-enhanced MRI at 7-T can indicate USPIO uptake in lymph nodes based on computed TE images. • Our method promises a high spatial resolution for pelvic lymph node imaging.
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Affiliation(s)
- Bart W J Philips
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands.
| | - Rutger C H Stijns
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands
| | - Stefan H G Rietsch
- Erwin L Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany.,High-Field and Hybrid MR Imaging, University Hospital Essen, 45147, Essen, Germany
| | - Sascha Brunheim
- Erwin L Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany.,High-Field and Hybrid MR Imaging, University Hospital Essen, 45147, Essen, Germany
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands
| | - Ansje S Fortuin
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands.,Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Harald H Quick
- Erwin L Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany.,High-Field and Hybrid MR Imaging, University Hospital Essen, 45147, Essen, Germany
| | - Stephan Orzada
- Erwin L Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany.,High-Field and Hybrid MR Imaging, University Hospital Essen, 45147, Essen, Germany
| | - Marnix C Maas
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, P.O. Box 9101, Nijmegen, The Netherlands.,Erwin L Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141, Essen, Germany
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Fortuin AS, Brüggemann R, van der Linden J, Panfilov I, Israël B, Scheenen TWJ, Barentsz JO. Ultra-small superparamagnetic iron oxides for metastatic lymph node detection: back on the block. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2017; 10. [PMID: 28382713 PMCID: PMC5763341 DOI: 10.1002/wnan.1471] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/22/2017] [Accepted: 02/25/2017] [Indexed: 12/25/2022]
Abstract
In the past 15 years, encouraging clinical results for the detection of small lymph node metastases was obtained by the use of Combidex‐enhanced MRI (CEM, also known as magnetic resonance lymphography). Withdrawal of the European Medicines Agency approval application by the manufacturer made it impossible for patients to benefit from this agent; a loss, especially for men with prostate cancer. Current conventional imaging techniques are not as accurate as CEM is, thus a surgical diagnostic exploration (extended lymph node dissection) is still the preferred technique to evaluate the lymph nodes, resulting in peri‐ and postoperative complications. In 2013, the Radboud University Medical Center (Radboudumc) obtained all licenses and documentation for the production process of Combidex (ferumoxtran‐10), and manufactured the contrast agent under supervision of the Department of Pharmacy. Since 2014, 310 men with prostate cancer have been examined with CEM in the Radboudumc. Within this cohort, seven minor possibly contrast‐related adverse effects were observed after administration of Combidex. As the contrast agent is now back again in the Netherlands, this review highlights the working mechanism, previous results, observed side effects since the reintroduction, and the future perspectives for Combidex. WIREs Nanomed Nanobiotechnol 2018, 10:e1471. doi: 10.1002/wnan.1471 This article is categorized under:
Diagnostic Tools > In Vivo Nanodiagnostics and Imaging Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease
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Affiliation(s)
- Ansje S Fortuin
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology and Nuclear Medicine, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Roger Brüggemann
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janine van der Linden
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilia Panfilov
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas Israël
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Debats OA, Fortuin AS, Meijer HJM, Hambrock T, Litjens GJS, Barentsz JO, Huisman HJ. Intranodal signal suppression in pelvic MR lymphography of prostate cancer patients: a quantitative comparison of ferumoxtran-10 and ferumoxytol. PeerJ 2016; 4:e2471. [PMID: 27781154 PMCID: PMC5075689 DOI: 10.7717/peerj.2471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/22/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The key to MR lymphography is suppression of T2* MR signal in normal lymph nodes, while retaining high signal in metastatic nodes. Our objective is to quantitatively compare the ability of ferumoxtran-10 and ferumoxytol to suppress the MR signal in normal pelvic lymph nodes. METHODS In 2010, a set of consecutive patients who underwent intravenous MR Lymphography (MRL) were included. Signal suppression in normal lymph nodes in T2*-weighted images due to uptake of USPIO (Ultra-Small Superparamagnetic Particles of Iron Oxide) was quantified. Signal suppression by two USPIO contrast agents, ferumoxtran-10 and ferumoxytol was compared using Wilcoxon's signed rank test. RESULTS Forty-four patients were included, of which all 44 had a ferumoxtran-10 MRL and 4 had additionally a ferumoxytol MRL. A total of 684 lymph nodes were identified in the images, of which 174 had been diagnosed as metastatic. USPIO-induced signal suppression in normal lymph nodes was significantly stronger in ferumoxtran-10 MRL than in ferumoxytol MRL (p < 0.005). CONCLUSIONS T2* signal suppression in normal pelvic lymph nodes is significantly stronger with ferumoxtran-10 than with ferumoxytol, which may affect diagnostic accuracy.
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Affiliation(s)
- Oscar A Debats
- Department of Radiology and Nuclear Medicine, Radboudumc , Nijmegen , The Netherlands
| | - Ansje S Fortuin
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands; Department of Radiology, Ziekenhuis Gelderse Vallei, Ede, The Netherlands
| | - Hanneke J M Meijer
- Department of Radiation Oncology, Radboudumc , Nijmegen , The Netherlands
| | - Thomas Hambrock
- Department of Radiology and Nuclear Medicine, Radboudumc , Nijmegen , The Netherlands
| | - Geert J S Litjens
- Department of Radiology and Nuclear Medicine, Radboudumc , Nijmegen , The Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc , Nijmegen , The Netherlands
| | - Henkjan J Huisman
- Department of Radiology and Nuclear Medicine, Radboudumc , Nijmegen , The Netherlands
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Philips BWJ, Fortuin AS, Orzada S, Scheenen TWJ, Maas MC. High resolution MR imaging of pelvic lymph nodes at 7 Tesla. Magn Reson Med 2016; 78:1020-1028. [PMID: 27714842 DOI: 10.1002/mrm.26498] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/30/2016] [Accepted: 09/16/2016] [Indexed: 11/06/2022]
Abstract
PURPOSE Pelvic lymph node (PLN) metastases are often smaller than 5 mm and difficult to detect. This work presents a method to perform PLN imaging with ultrahigh-field MRI, using spectrally selective excitation to acquire water and lipid-selective imaging at high spatial resolution. METHODS A 3D water-selective multigradient echo (mGRE) sequence and lipid-selective gradient echo (GRE) sequence were tested in six healthy volunteers on a 7 Tesla (T) MRI system, using time interleaved acquisition of modes (TIAMO) to improve image homogeneity. The size distribution of the first 10 iliac PLNs detected in each volunteer was determined, and the contrast-to-noise ratio (CNR) of these lymph nodes (LNs) was compared with the individual mGRE images, sum-of-squares echo addition, and computed T2*-weighted images derived from the T2* fits. RESULTS LN imaging was acquired robustly at ultrahigh field with high resolution and homogeneous lipid or water-selective contrast. PLNs down to 1.5-mm short axis were detected with mean ± standard error of the mean (SEM) short and long axes of 2.2 ± 0.1 and 3.7 ± 0.2 mm, respectively. Computed T2*-weighted imaging allowed flexibility in T2* contrast while featuring a CNR up to 90% of the sum-of-squares echo addition. CONCLUSION Ultrahigh-field MRI in combination with TIAMO and frequency-selective excitation enables high-resolution, large field-of-view MRI of the lower abdomen, and may ultimately be suitable for detecting small PLN metastases. Magn Reson Med 78:1020-1028, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Bart W J Philips
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ansje S Fortuin
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Stephan Orzada
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, UNESCO World Cultural Heritage Zollverein, Essen, Germany
| | - Tom W J Scheenen
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, Nijmegen, the Netherlands.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, UNESCO World Cultural Heritage Zollverein, Essen, Germany
| | - Marnix C Maas
- Department of Radiology and Nuclear Medicine (766), Radboud University Medical Center, Nijmegen, the Netherlands
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Fortuin AS, Meijer H, Thompson LC, Witjes JA, Barentsz JO. Ferumoxtran-10 ultrasmall superparamagnetic iron oxide-enhanced diffusion-weighted imaging magnetic resonance imaging for detection of metastases in normal-sized lymph nodes in patients with bladder and prostate cancer: do we enter the era after extended pelvic lymph node dissection? Eur Urol 2013; 64:961-3; discussion 963. [PMID: 23972400 DOI: 10.1016/j.eururo.2013.08.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 08/07/2013] [Indexed: 12/19/2022]
Affiliation(s)
- Ansje S Fortuin
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Meijer HJ, Fortuin AS, van Lin EN, Debats OA, Witjes JA, Kaanders JH, Barentsz JO. Corrigendum to “Geographical distribution of lymph node metastases on MR lymphography in prostate cancer patients” [Radiother Oncol 106 (2013) 59–63]. Radiother Oncol 2013. [DOI: 10.1016/j.radonc.2013.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fortuin AS, Barentsz JO. Comments on Ultrasmall superparamagnetic particles of iron oxide allow for the detection of metastases in normal sized pelvic lymph nodes of patients with bladder and/or prostate cancer, Triantafyllou et al., European Journal of Cancer, published online 22 October 2012. Eur J Cancer 2013; 49:1789-90. [PMID: 23465494 DOI: 10.1016/j.ejca.2013.01.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 01/21/2013] [Indexed: 11/30/2022]
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Meijer HJM, Fortuin AS, van Lin ENJT, Debats OA, Alfred Witjes J, Kaanders JHAM, Barentsz JO. Geographical distribution of lymph node metastases on MR lymphography in prostate cancer patients. Radiother Oncol 2012. [PMID: 23199653 DOI: 10.1016/j.radonc.2012.10.021] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the pattern of lymph node spread on magnetic resonance lymphography (MRL) in prostate cancer patients and compare this pattern to the clinical target volume for elective pelvis irradiation as defined by the radiation therapy oncology group (RTOG-CTV). METHODS AND MATERIALS The charts of 60 intermediate and high risk prostate cancer patients with non-enlarged positive lymph nodes on MRL were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines for delineation of the RTOG-CTV. Five lymph node regions outside this RTOG-CTV were defined: the para-aortal, proximal common iliac, pararectal, paravesical and inguinal region. RESULTS Fifty-three percent of the patients had an MRL-positive lymph node in a lymph node region outside the RTOG-CTV. The most frequently involved aberrant sites were the proximal common iliac, the pararectal and para-aortal region, which were affected in 30%, 25% and 18% respectively. CONCLUSION More than half of the patients had an MRL-positive lymph node outside the RTOG-CTV. To reduce geographical miss while minimizing the toxicity of radiotherapy, image based definition of an individual target volume seems to be necessary.
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Affiliation(s)
- Hanneke J M Meijer
- Department of Radiation Oncology, Radbound University Nijmegen, Medical Centre, Nijmegen, The Netherlands.
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Deserno WM, Debats OA, Rozema T, Fortuin AS, Heesakkers RA, Hoogeveen Y, Peer PG, Barentsz JO, van Lin EN. Comparison of Nodal Risk Formula and MR Lymphography for Predicting Lymph Node Involvement in Prostate Cancer. Int J Radiat Oncol Biol Phys 2011; 81:8-15. [DOI: 10.1016/j.ijrobp.2010.05.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 04/12/2010] [Accepted: 05/08/2010] [Indexed: 11/28/2022]
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