Andrea Rockall MBBS, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Numerous studies on MRI in patients with pelvic malignancy show that standard size criteria are inaccurate in detecting lymph node infiltration. Our aim was to assess the diagnostic performance of USPIOs in the diagnosis of lymph node metastases in female patients with pelvic malignancy, using histology as the gold standard. Methods and Materials: 39 patients were studied (13 endometrial, 20 cervical, 5 vulva and 1 perineal recurrence of bladder carcinoma), with a mean age of 49 yrs (range 26 - 78). MRI was performed with a 1.5T GE Signa Horizon scanner and a phased array coil. Axial T2 weighted (TR 4 - 6000, TE 90 - 120, ETL 8) and T2* weighted (GRE, 30 degree flip angle, TR 7 - 800, TE 15) sequences were performed, supplemented by T2* sequences in the coronal or oblique sagittal plane, before and after the administration of 2.7 mg/kg of USPIO. Two independent blinded observers reviewed the images. Nodal status on post USPIO scans was diagnosed based on a subjective observation of darkening of the node, indicating negativity, or lack of darkening, indicating positivity. On conventional scans, nodal infiltration was diagnosed using a size criterion of =>1 cm. In all patients, pathological correlation was available following lymphadenectomy (33) or percutaneous biopsy (6) Results: Lymph node pathology was available in 546 nodes, of which 252 could be correlated on MRI. On a node-by-node analysis, using size criteria, detection of nodal metastases was made with a sensitivity of 53%, specificity 98%, PPV 69% and NPV 96%; and using USPIO criteria, the sensitivity was 86/88% (observer 1/observer 2), specificity 98/97%, PPV 75/68% and NPV 99/99%. On a patient-by-patient basis, using size criteria, detection of one or more nodal metastasis was made with a sensitivity of 50%, specificity of 96%, PPV of 87% and NPV of 77%; using USPIO criteria, the sensitivity was 85/86% (observer 1/observer 2), specificity 100/83%, PPV 100/75%, NPV 93/91%. The increases in sensitivity and NPV approached but did not reach statistical significance. Conclusion: This study shows that MRI with USPIO is highly accurate in the detection of lymph node infiltration in female patients with a pelvic malignancy and is likely to be of great value in the pre-operative planning of patients with gynaecological malignancy.       Questions about this event email: a.g.rockall@qmul.ac.uk

Rockall MBBS, A, Diagnostic Performance of MR with Ultrasmall Particles of Iron Oxide in the Diagnosis of Lymph Node Metastases in Gynaecological Malignancy.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3101580.html