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Comparison of Lymphotropic Nanoparticle-Enhanced MRI Sequences in Patients with Various Primary Cancers

Mansi Saksena1, Mukesh Harisinghani1, Peter Hahn1, John Kim1, Anuradha Saokar1, Benjamin King1 and Ralph Weissleder1

1 All authors: Division of Abdominal Imaging, Massachusetts General Hospital and Harvard Medical School, White 270, 55 Fruit Street, Boston, MA 02114.


Figure 1
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  		Fig. 1 —Diagnostic guidelines used for nodal characterization on lymphotropic nanoparticle-enhanced MRI. Adapted from [21].

 

Figure 2
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  		Fig. 2A —85-year-old woman with bladder cancer. Unenhanced T2-weighted MRI image shows enlarged left external iliac lymph node (arrow) with minimal drop in signal intensity.

 

Figure 3
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  		Fig. 2B —85-year-old woman with bladder cancer. Unenhanced T2*-weighted MRI image shows enlarged left external iliac lymph node (arrow) with more prominent loss in signal intensity than on T2-weighted images. This is characteristic of benign lymph node and diagnosis was confirmed by CT-guided biopsy.

 

Figure 4
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  		Fig. 2C —85-year-old woman with bladder cancer. Unenhanced heavily T2*-weighted MRI image shows enlarged left external iliac lymph node (arrow) with more prominent loss in signal intensity than on T2-weighted images. This is characteristic of benign lymph node and diagnosis was confirmed by CT-guided biopsy.

 

Figure 5
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  		Fig. 2D —85-year-old woman with bladder cancer. Contrast-enhanced T2-weighted MRI image shows enlarged left external iliac lymph node (arrow) with minimal drop in signal intensity.

 

Figure 6
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  		Fig. 2E —85-year-old woman with bladder cancer. Contrast-enhanced T2*-weighted MRI image shows enlarged left external iliac lymph node (arrow) with more prominent loss in signal intensity than on T2-weighted images. This is characteristic of benign lymph node and diagnosis was confirmed by CT-guided biopsy.

 

Figure 7
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  		Fig. 2F —85-year-old woman with bladder cancer. Contrast-enhanced heavily T2*-weighted MRI image shows enlarged left external iliac lymph node (arrow) with more prominent loss in signal intensity than on T2-weighted images. This is characteristic of benign lymph node and diagnosis was confirmed by CT-guided biopsy.

 

Figure 8
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  		Fig. 3A —61-year-old man with prostate cancer. Unenhanced T2-weighted image shows hyperintense 7-mm left external iliac lymph node (arrow). Node is benign by size criteria.

 

Figure 9
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  		Fig. 3B —61-year-old man with prostate cancer. Unenhanced T2*-weighted image shows hyperintense 7-mm left external iliac lymph node (arrow). Node is benign by size criteria.

 

Figure 10
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  		Fig. 3C —61-year-old man with prostate cancer. Unenhanced heavily T2*-weighted image shows hyperintense 7-mm left external iliac lymph node (arrow). Node is benign by size criteria. This node was sampled at surgery and found to be completely replaced by metastatic prostate cancer.

 

Figure 11
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  		Fig. 3D —61-year-old man with prostate cancer. Contrast-enhanced T2-weighted image of 7-mm left external iliac lymph node (arrow) shows no drop in signal intensity. Such an appearance on contrast-enhanced lymphotropic nanoparticle-enhanced MRI is diagnostic of metastatic node.

 

Figure 12
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  		Fig. 3E —61-year-old man with prostate cancer. Contrast-enhanced T2*-weighted image of 7-mm left external iliac lymph node (arrow) shows no drop in signal intensity. Such an appearance on contrast-enhanced lymphotropic nanoparticle-enhanced MRI is diagnostic of metastatic node.

 

Figure 13
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  		Fig. 3F —61-year-old man with prostate cancer. Contrast-enhanced heavily T2*-weighted image of 7-mm left external iliac lymph node (arrow) shows no drop in signal intensity. Such an appearance on contrast-enhanced lymphotropic nanoparticle-enhanced MRI is diagnostic of metastatic node. This node was sampled at surgery and found to be completely replaced by metastatic prostate cancer.

 

Figure 14
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  		Fig. 4A —59-year-old man with penile cancer. Unenhanced heavily T2*-weighted (A) and contrast-enhanced heavily T2*-weighted (B) images obtained with TE of 21 msec show two left inguinal lymph nodes (arrows, A). Contrast-enhanced image (B) shows a drop in signal intensity (arrows, B) compared with unenhanced image (A). This was interpreted as malignant nodal infiltration. Patient underwent inguinal lymphadenectomy, which revealed nodal fibrosis without any evidence of malignancy.

 

Figure 15
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  		Fig. 4B —59-year-old man with penile cancer. Unenhanced heavily T2*-weighted (A) and contrast-enhanced heavily T2*-weighted (B) images obtained with TE of 21 msec show two left inguinal lymph nodes (arrows, A). Contrast-enhanced image (B) shows a drop in signal intensity (arrows, B) compared with unenhanced image (A). This was interpreted as malignant nodal infiltration. Patient underwent inguinal lymphadenectomy, which revealed nodal fibrosis without any evidence of malignancy.

 

Figure 16
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  		Fig. 5A —58-year-old man patient with prostate cancer. Reprinted with permission from [17]. Contrast-enhanced T2* image obtained with shorter TE shows 4-mm left external iliac node with central heterogeneity (arrow), a finding that can be interpreted as representing malignant infiltration.

 

Figure 17
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  		Fig. 5B —58-year-old man patient with prostate cancer. Reprinted with permission from [17]. Contrast-enhanced heavily T2*-weighted image obtained at same time as A but with longer TE shows more homogeneous drop in signal intensity (arrow), which is consistent with benign node. This node was benign on pathologic analysis.

 

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