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Abdominal Imaging

, Volume 38, Issue 4, pp 720–727 | Cite as

Gadofosveset-enhanced MRI for the assessment of rectal cancer lymph nodes: predictive criteria

  • Doenja M. J. Lambregts
  • Luc A. Heijnen
  • Monique Maas
  • Iris J. G. Rutten
  • Milou H. Martens
  • Walter H. Backes
  • Robert G. Riedl
  • Frans C. H. Bakers
  • Vincent C. Cappendijk
  • Geerard L. Beets
  • Regina G. H. Beets-Tan
Article

Abstract

Purpose

To confirm the use of the nodal signal intensity (SI) and the ‘chemical shift’ artefact as diagnostic criteria for detecting nodal metastases from rectal cancer on gadofosveset contrast-enhanced MRI.

Methods

Thirty-three patients underwent a non-enhanced and gadofosveset-enhanced 3D-T1W GRE-MRI at 1.5T. For each lymph node, the SI of the middle part of the node (mSI) and white rim of the chemical shift artefact encircling the node (wSI) were measured on the non-enhanced and gadofosveset-enhanced images. Second, the aspect of the chemical shift artefact encircling the nodes was scored using a 4-point scale. Results were compared with histology on a node-by-node basis.

Results

289 nodes (55 N+) were analysed. On gadofosveset-MRI, mSI and wSI were significantly higher for the benign than for the metastatic lymph nodes (p < 0.001). Areas under the ROC curve (AUC) for identification of metastases were 0.74 (mSI) and 0.73 (wSI). The chemical shift criterion rendered an AUC of 0.85. The combination of mSI and the chemical shift criterion resulted in an AUC of 0.88 and the rendered an AUC of 0.86–0.92 when subjectively (visually) assessed by two independent readers.

Conclusions

Benign lymph nodes show significant contrast enhancement after gadofosveset injection, while metastatic nodes do not. The uptake of gadofosveset in the nodes also affects the chemical shift artefact encircling the nodes. Combined assessment of these two features on gadofosveset-enhanced MRI provides a high diagnostic performance for diagnosing metastatic lymph nodes in patients with rectal cancer.

Keywords

Rectal neoplasms Magnetic resonance imaging Contrast agents Lymph nodes Diagnostic imaging 

References

  1. 1.
    Kapiteijn E, Marijnen CA, Nagtegaal ID, et al. (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–646PubMedCrossRefGoogle Scholar
  2. 2.
    Lezoche G, Baldarelli M, Guerrieri M, et al. (2008) A prospective randomized study with a 5-year minimum follow-up evaluation of transanal endoscopic microsurgery versus laparoscopic total mesorectal excision after neoadjuvant therapy. Surg Endosc 22:352–358PubMedCrossRefGoogle Scholar
  3. 3.
    Habr-Gama A, Perez RO, Proscurshim I, et al. (2006) Patterns of failure and survival for nonoperative treatment of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg 10:1319–1328 (discussion 1328-1319)PubMedCrossRefGoogle Scholar
  4. 4.
    Bipat S, Glas AS, Slors FJ, et al. (2004) Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging–a meta-analysis. Radiology 232:773–783PubMedCrossRefGoogle Scholar
  5. 5.
    Lahaye MJ, Engelen SM, Nelemans PJ, et al. (2005) Imaging for predicting the risk factors—the circumferential resection margin and nodal disease—of local recurrence in rectal cancer: a meta-analysis. Semin Ultrasound CT MR 26:259–268PubMedCrossRefGoogle Scholar
  6. 6.
    Will O, Purkayastha S, Chan C, et al. (2006) Diagnostic precision of nanoparticle-enhanced MRI for lymph-node metastases: a meta-analysis. Lancet Oncol 7:52–60PubMedCrossRefGoogle Scholar
  7. 7.
    Lahaye MJ, Engelen SM, Kessels AG, et al. (2008) USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer: predictive criteria. Radiology 246:804–811PubMedCrossRefGoogle Scholar
  8. 8.
    Koh D-M, Brown G, Temple L, et al. (2004) Rectal cancer: mesorectal lymph nodes at MR imaging with USPIO versus histopathologic findings—initial observations. Radiology 231:91–99PubMedCrossRefGoogle Scholar
  9. 9.
    Lambregts DM, Beets GL, Maas M, et al. (2011) Accuracy of gadofosveset-enhanced MRI for nodal staging and restaging in rectal cancer. Ann Surg 253:539–545PubMedCrossRefGoogle Scholar
  10. 10.
    Marijnen CA, Nagtegaal ID, Klein Kranenbarg E, et al. (2001) No downstaging after short-term preoperative radiotherapy in rectal cancer patients. J Clin Oncol 19:1976–1984PubMedGoogle Scholar
  11. 11.
    Lahaye MJ, Beets GL, Engelen SME, et al. (2009) Gadofosveset Trisodium (Vasovist®) enhanced MR lymph node detection: initial observations. Open Magn Resonance J 2:1–5CrossRefGoogle Scholar
  12. 12.
    Wang C, Zhou Z, Wang Z, et al. (2005) Patterns of neoplastic foci and lymph node micrometastasis within the mesorectum. Langenbecks Arch Surg 390:312–318PubMedCrossRefGoogle Scholar
  13. 13.
    Misselwitz B (2006) MR contrast agents in lymph node imaging. Eur J Radiol 58:375–382PubMedCrossRefGoogle Scholar
  14. 14.
    Herborn CU, Lauenstein TC, Vogt FM, et al. (2002) Interstitial MR lymphography with MS-325: characterization of normal and tumor-invaded lymph nodes in a rabbit model. AJR Am J Roentgenol 179:1567–1572PubMedCrossRefGoogle Scholar
  15. 15.
    Yamashita T, Takahara T, Kwee TC, et al. (2011) Diffusion magnetic resonance imaging with gadofosveset trisodium as a negative contrast agent for lymph node metastases assessment. Jpn J Radiol 29:25–32PubMedCrossRefGoogle Scholar
  16. 16.
    Borschitz T, Wachtlin D, Mohler M, Schmidberger H, Junginger T (2008) Neoadjuvant chemoradiation and local excision for T2–3 rectal cancer. Ann Surg Oncol 15:712–720PubMedCrossRefGoogle Scholar
  17. 17.
    Maas M, Beets-Tan RG, Lambregts DM, et al. (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal cancer. J Clin Oncol 29:4633–4640PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Doenja M. J. Lambregts
    • 1
  • Luc A. Heijnen
    • 1
    • 2
  • Monique Maas
    • 1
  • Iris J. G. Rutten
    • 1
  • Milou H. Martens
    • 1
    • 2
  • Walter H. Backes
    • 1
  • Robert G. Riedl
    • 3
  • Frans C. H. Bakers
    • 1
  • Vincent C. Cappendijk
    • 1
  • Geerard L. Beets
    • 2
  • Regina G. H. Beets-Tan
    • 1
  1. 1.Department of RadiologyMaastricht University Medical CenterMaastrichtThe Netherlands
  2. 2.Department of SurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  3. 3.Department of PathologyMaastricht University Medical CenterMaastrichtThe Netherlands

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