Ferumoxytol-Enhanced MR Lymphography for Detection of Metastatic Lymph Nodes in Genitourinary Malignancies: A Prospective Study.

Abstract

OBJECTIVE. The objective of our study was to evaluate the utility of ferumoxytol-enhanced MR lymphography (MRL) in detection of metastatic lymph nodes (LNs) in patients with prostate, bladder, and kidney cancer. SUBJECTS AND METHODS. This phase 2 single-institution study enrolled patients with confirmed prostate (arm 1), bladder (arm 2), and kidney (arm 3) cancer and evidence of suspected LN involvement. Participants underwent ferumoxytol-enhanced MRL 24 and 48 hours after IV injection of 7.5 mg Fe/kg of ferumoxytol. A retrospective quantitative analysis was performed to determine the optimal timing for ferumoxytol-enhanced MRL using percentage change in normalized signal intensity (SI) from baseline to 24 and 48 hours after injection, which were estimated using the linear mixed-effects model in which time (24 vs 48 hours), diseases status, and time and disease status interaction were the fixed-effects independent variables. Differences in normalized SI values between subgroups of lesions were estimated by forming fixed-effects contrasts and tested by the Wald test. RESULTS. Thirty-nine patients (n = 30, arm 1; n = 6, arm 2; n = 3, arm 3) (median age, 65 years) with 145 LNs (metastatic, n = 100; benign, n = 45) were included. LN-based sensitivity, specificity, positive predictive value, and negative predictive value of ferumoxytol-enhanced MRL was 98.0%, 64.4%, 86.0%, and 93.5%, respectively. Sensitivity and specificity of ferumoxytol-enhanced MRL did not vary by LN size. Metastatic LNs showed a significantly higher percentage decrease of normalized SI on MRL at 24 hours after ferumoxytol injection than at 48 hours after ferumoxytol injection (p = 0.023), whereas the normalized SI values for nonmetastatic LNs were similar at both imaging time points (p = 0.260). CONCLUSION. Ferumoxytol-enhanced MRL shows high sensitivity in the detection of metastatic LNs in genitourinary cancers independent of LN size. The SI difference between benign and malignant LNs on ferumoxytol-enhanced MRL appears similar 24 and 48 hours after ferumoxytol injection, suggesting that imaging can be performed safely within 1 or 2 days of injection. Although ferumoxytol-enhanced MRL can be useful in settings without an available targeted PET agent, issues of iron overload and repeatability of ferumoxytol-enhanced MRL remain concerns for this method.

• Authors: Baris Turkbey, Marcin Czarniecki, Joanna H Shih, Stephanie A Harmon, Piyush K Agarwal, Andrea B Apolo, Deborah E Citrin, James L Gulley, Mukesh Harisinghani, Ravi A Madan, Adam R Metwalli, Edmond Paquette, Peter A Pinto, Soroush Rais-Bahrami, Lindsay S Rowe, Bradford J Wood, Paula M Jacobs, Liza Lindenberg, William Dahut, Peter L Choyke
• Journal: AJR. American journal of roentgenology (AJR Am J Roentgenol) Vol. 214 Issue 1 Pg. 105-113 (01 2020) ISSN: 1546-3141 [Electronic] United States
• PMID: 31613660 (Publication Type: Clinical Trial, Phase II, Journal Article)

Chemical References

• Ferrosoferric Oxide

Topics

• Adult
• Aged
• Aged, 80 and over
• Ferrosoferric Oxide
• Humans
• Kidney Neoplasms (pathology)
• Lymphatic Metastasis (diagnostic imaging)
• Lymphography (methods)
• Magnetic Resonance Imaging (methods)
• Male
• Middle Aged
• Prospective Studies
• Prostatic Neoplasms (pathology)
• Retrospective Studies
• Urinary Bladder Neoplasms (pathology)