title: Pilot study evaluating use of lymphotrophic nanoparticle-enhanced magnetic resonance imaging for assessing lymph nodes in renal cell cancer.
abstract: OBJECTIVE
  To assess lymphotrophic nanoparticle-enhanced magnetic resonance imaging (LNMRI) in identifying malignant nodal involvement in patients with renal neoplasms.
  
  
  METHODS
  MRI was performed in 9 patients with renal masses. All patients were imaged on a GE 1.5T system with phased array body coil. Protocols included T2 and T2* weighted imaging before and after administration of ferumoxtran-10 (Combidex) for the evaluation of lymph node (LN) involvement. All 9 patients underwent nephrectomy. Lymph node dissection (LND) was performed in patients with stage 2 renal cell cancer (RCC), or transitional cell cancer (TCC), per routine clinical practice. Data analysis was performed by 2 radiologists, who were blinded to pathologic results. Nodes that lacked contrast uptake were deemed malignant, and those with homogeneous uptake were deemed benign. Quantitative, retrospective analysis was performed on primary tumors by quantifying T2* with a monoexponential fitting algorithm (Osirix). T2* was quantified before, immediately after, and 24 hours after the administration of ferumoxtran-10.
  
  
  RESULTS
  MRI demonstrated 26 lymph nodes within the 9 patients imaged (24 benign and 2 malignant). Pathologic results allowed comparison in 22 of the 26 lymph nodes and demonstrated high sensitivity (100%) and specificity (95.7%).
  
  
  CONCLUSIONS
  LNMRI demonstrated high sensitivity (100%) and specificity (95.7%) in patients with renal neoplasms. Although in a relatively small sample size, the results are encouraging and warrant a larger, prospective trial.
authors.affiliation: Center for Molecular Imaging Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA. aguimaraes1@partners.org
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Guimaraes
authors.forename: Shahin
authors.initials: S
authors.lastname: Tabatabei
authors.forename: Douglas
authors.initials: D
authors.lastname: Dahl
authors.forename: W Scott
authors.initials: WS
authors.lastname: McDougal
authors.forename: Ralph
authors.initials: R
authors.lastname: Weissleder
authors.forename: Mukesh G
authors.initials: MG
authors.lastname: Harisinghani
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000556:secondary* / Q000601:surgery; D003287:Contrast Media; D003911:Dextrans; D005260:Female; D052203:Ferrosoferric Oxide; D006801:Humans; D007501:Iron; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy; D010087:Oxides; D010865:Pilot Projects; D011237:Predictive Value of Tests
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; D010087:Oxides; C097921:ferumoxtran-10; D007501:Iron; D052203:Ferrosoferric Oxide