In direct comparison with gallium-68 (Ga-68) prostate-specific membrane antigen (PSMA) PET / CT, MR imaging with a nanoparticle interfacing agent ferumoxtran-10 (nano-MRI) identified a much greater number of malignant lymph nodes, which moreover as nodes that were much smaller. At the same time, the two procedures were relatively complementary, as they both found some lymph nodes that lost the other model.
“While there is no reference standard in this study, the key findings outlined above give us an insight into the overall performance of both models by identifying areas of agreement and disagreement. -agree, “wrote the authors led by Dr. Melline Schilham from Radboud University Medical Center, Nijmegen, The Netherlands.” Such findings allow the definition of future areas of research that need to be defined. deal to explain the best imaging strategy for prostate cancer patients. “
The most effective dissection is the potential health risk of lymph nodes in prostate cancer cases. Because dissection is an invasive procedure that can put a patient at risk for other adverse conditions, there is “a growing demand and place for noninvasive imaging techniques to detect lymph node metastases in prostate cancer patients. , ”Wrote Schilham and colleagues.
Ga-68 PSMA PET / CT has been visited in several studies for its ability in accurately diagnosing prostate cancer and directing patients to the most appropriate treatments. In addition, nano-MRI, also known as MR lymphography, has attracted attention using ferumoxtran-10 (Ferrotran, SPL Medical) to differentiate between malignant and malignant metastatic lymph nodes. strange commands. One study found that nano-MRI with the ultra-small iron oxide grain interface agent achieved 82% sensitivity and 93% specificity.
“Because both models rely on different technical and biological features, there was an idea that combined use could even improve lymph node detection,” the authors wrote.
Therefore, they set out to investigate the “feasibility of a complementary role for these imaging modalities by comparing their results in the same patient.[s] and identify differences and similarities in detected lymph node characteristics, regardless of reference level. “
This retrospective study looked at 45 patients (average age, 64 years; range 48–82 years) with primary prostate cancer (8 patients, 18%) or recurrent (36 patients, 82%). Within three weeks, all subjects underwent Ga-68 PSMA PET / CT (Biograph mCT, Siemens Healthineers) with a detection dose of 2 MBq / kg body weight and 3-tesla MRI scans (Magnetom Skyra or Trio, Siemens) with ferumoxtran-10 doses based on a body weight of 2.6 mg / kg and administered 24 to 36 hours prior to MRI. The combined results revealed a total of 179 suspected lymph nodes in 33 patients, with at least three or more lymph nodes per patient.
One set of images (A) shows a 7-mm diameter lymph node positive on both nano-MRI and PSMA-PET / CT in the patient’s left pararectal area. For comparison, the other image set (B) shows a 4-mm diameter lymph node that was tested positive on nano-MRI (left) but negative on PSMA-PET / CT (right) without Tracer Ga-68 PSMA capture in the area (green circle). Photos courtesy of Journal of Nuclear Medicine.
Nano-MRI was significantly better at detecting 160 suspicious lymph nodes (89%) in the 33 patients (100%), compared to 71 suspicious lymph nodes (40%) who detected PSMA PET / CT in 27 patients (82%) (p <0.001). Of the 160 suspicious lymph nodes, only 108 (60%) were detected by nano-MRI, and PSMA PET / CT was the only identifier of 19 (11%) suspicious lymph nodes and both models saw similar 52 (29%). ) suspicious disorders. .
In addition, nano-MRI found much smaller suspicious lymph nodes (average size, 5.2 mm; range, 2-16 mm), compared to Ga-68 PSMA PET / CT (average size, 6 mm; range, 3-16 mm) (p = 0.006).
The fact that the two models of suspicious lymph nodes found the other missing imaging method suggests “a possible complementary role for nano-MRI to PSMA-PET / CT,” said Schilham and colleagues. “However, as the clinical effects of the various outcomes are not yet well established, further study is encouraged in this complementary practice.”
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