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Lymphotropic Nanoparticle–Enhanced MRI for Independent Prediction of Lymph Node Malignancy: A Logistic Regression Model

¹ Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St., 10th fl., Boston, MA 02114.
² Department of Radiology, Massachusetts General Hospital, Boston, MA.
³ Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Boston, MA.
⁴ Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA.
⁵ 3D Imaging Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA.

OBJECTIVE. The purpose of this study was to determine whether use of lymphotropic nanoparticle–enhanced MRI can improve the ability to characterize lymph nodes as benign or malignant beyond size criteria alone.

MATERIALS AND METHODS. The cases of 42 consecutively registered patients with a known primary malignant tumor of the genitourinary tract who underwent both lymphotropic nanoparticle–enhanced MRI and CT-guided biopsy of a lymph node at our institution from 2000 to 2005 were retrospectively identified. Lymphotropic nanoparticle–enhanced MRI included T2^*-weighted gradient-recalled echo imaging before and 24–36 hours after IV administration of lymphotropic iron oxide nanoparticles. Two positivity criteria for lymph node malignancy were evaluated independently: lack of nanoparticle uptake at lymphotropic nanoparticle–enhanced MRI and short-axis length of 1 cm or greater. Sensitivity and specificity were calculated for each criterion with biopsy results as the standard of reference. Logistic regression analysis was used to determine the association (odds ratio) between lymphotropic nanoparticle–enhanced MRI findings and the presence of lymph node malignancy when controlling for short-axis length.

RESULTS. Metastatic lesions were detected at histologic examination in 67% (28/42) of nodes. According to the lymphotropic nanoparticle–enhanced MRI criterion, sensitivity for malignancy was 100% (28/28 nodes), and specificity was 64% (9/14 nodes). According to the short-axis criterion, sensitivity was 79% (22/28 nodes), and specificity was 21% (3/14 nodes). In multivariate analysis, when controlling for short-axis length, the finding of malignancy at lymphotropic nanoparticle–enhanced MRI was an independent predictor of the presence of malignancy (odds ratio, 61.0; 95% CI, 8.0 to infinity; p < 0.0001).

CONCLUSION. Use of lymphotropic nanoparticle–enhanced MRI may improve ability to characterize lymph nodes beyond size criteria alone. Our results emphasize the need to further assess lymphotropic nanoparticle–enhanced MRI in prospective large-scale studies with wider variation in the distribution of lymph node sizes and primary malignancies.

Keywords: ferumoxtran-10 • genitourinary cancer • MR lymphangiography • oncologic imaging • superparamagnetic iron oxide • ultrasmall particles

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