New MRI Techniques Uspio Mri

Previous reports have shown that the information about lymph nodes on MR images can be improved by pharmaceutical manipulation of tissue proton relaxation times. Ultra small Super Paramagnetic Iron Oxide Particles (USPIO) with a long plasma circulation time have been shown to be suitable as a MR contrast agent for intravenous MR lymphangiography (Fig. 21) [87-90]. In a study performed at UMC in Nijmegen and Mass General

Fig. 21. Normal size (5 mm) metastatic node (circle). a MDCT reconstruction in 'obturator' plane shows normal size (5 mm) node (circle). b On T2*-weighted MR image in identical plane obtained 24 hours post-USPIO, this node (circle) has high signal intensity which argues for metastasis. Also, two small normal nodes (arrows) are visible, which have low signal intensity due to accumulation of iron loaded macrophages in normal nodal tissue. These nodes are not visible on MDCT

in Boston [91], in 80 patients with histologically proven prostate cancer, using high-resolution techniques (at 1.5 T using a body phased-array coil), on post USPIO MRI the rate of detection of small nodal metastases in normal 5-8 mm sized nodes was significantly improved. Sensitivity, accuracy and negative predictive value showed a significant improvement using post-USPIO to 100%, 98% and 100%, respectively. This was due to the detection of small 3-4 mm metastases in normal-sized nodes. In addition, MRI nodes were found outside of the surgical field in 9 out of 80 patients thanks to post USPIO. Similar post USPIO results - sensitivity, accuracy and negative predictive value, respectively 96%, 95% and 98% - were acquired recently in urinary bladder cancer [93].

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