USPIO-enhanced magnetic resonance imaging for nodal staging in patients with head and neck cancer.
OBJECTIVE
To determine the accuracy of ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) for nodal staging in patients with head and neck cancer.


METHODS
Twenty patients with carcinomas of the upper aerodigestive tract were prospectively enrolled. MRI was performed before and 24-36 hours after intravenous infusion of an USPIO agent, ferumoxtran-10 (Sinerem; Guerbet, France; and Combidex; Advanced Magnetics) at a dose of 2.6 mg Fe/kg using T2-weighted spin-echo and gradient-echo sequences. Surgery was performed the same day or the day after the ferumoxtran-10-enhanced MR examination. Based on MRI, selected nodes were surgically removed and directly correlated with pathology using hematoxylin-eosin (H&E) and Perls stainings.


RESULTS
A total of 63 nodes were studied; 36 were nonmetastatic, 25 metastatic, and two inflammatory. Ferumoxtran-10-enhanced MRI allowed diagnosis of 24 metastatic and 30 nonmetastatic nodes, yielding a sensitivity of 96%, a specificity of 78.9%, a positive predictive value of 75%, and a negative predictive value of 96.8%, compared to 64%, 78.9%, 66.6%, and 76.9%, respectively, for nonenhanced MRI. Accuracy of ferumoxtran-10-enhanced MRI was 85.7%. The gradient-echo T2-weighted sequence was the most accurate to detect signal loss in nonmetastatic nodes.


CONCLUSIONS
USPIO-enhanced MRI is useful for nodal staging of patients with head and neck cancers.
Curvo-Semedo
Luís
L
Department of Radiology, Hospital Universidade de Coimbra, Coimbra, Portugal.
Diniz
Mónica
M
Miguéis
Jorge
J
Julião
Maria-José
MJ
Martins
Paula
P
Pinto
Alda
A
Caseiro-Alves
Filipe
F
D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology*; D003287:Contrast Media / Q000494:pharmacology*; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007501:Iron / Q000494:pharmacology*; D008208:Lymphatic System / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D010087:Oxides / Q000494:pharmacology*; D011237:Predictive Value of Tests
D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C097921:ferumoxtran-10; D007501:Iron; D052203:Ferrosoferric Oxide