6533b873fe1ef96bd12d592d

RESEARCH PRODUCT

Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI.

Heike E. Daldrup-linkHeike E. Daldrup-linkJayne SeekinsAllison PribnowFlorette K. HazardAnne M. MueheFlorian SiedekFlorian SiedekTie LiangSheri L. SpuntAshok J. TheruvathAshok J. Theruvath

subject

Malemedicine.medical_specialtyAdolescentAnemiaMRI contrast agentMedicine (miscellaneous)030218 nuclear medicine & medical imagingLesioncancer imaging03 medical and health sciences0302 clinical medicineFluorodeoxyglucose F18lymph nodesNeoplasmsferumoxytolmedicineHumansProspective StudiesChildPharmacology Toxicology and Pharmaceutics (miscellaneous)Lymph nodeReceiver operating characteristicbusiness.industryCell Differentiationmedicine.diseasePediatric cancerMagnetic Resonance ImagingFerrosoferric Oxide3. Good healthFerumoxytolmedicine.anatomical_structurePET/MRI030220 oncology & carcinogenesisPositron-Emission TomographyNanoparticlesFemaleRadiologyLymphmedicine.symptomRadiopharmaceuticalsbusinessResearch Paper

description

The composition of lymph nodes in pediatric patients is different from that in adults. Most notably, normal lymph nodes in children contain less macrophages. Therefore, previously described biodistributions of iron oxide nanoparticles in benign and malignant lymph nodes of adult patients may not apply to children. The purpose of our study was to evaluate if the iron supplement ferumoxytol improves the differentiation of benign and malignant lymph nodes in pediatric cancer patients on 18F-FDG PET/MRI. Methods: We conducted a prospective clinical trial from May 2015 to December 2018 to investigate the value of ferumoxytol nanoparticles for staging of children with cancer with 18F-FDG PET/MRI. Ferumoxytol is an FDA-approved iron supplement for the treatment of anemia and has been used “off-label” as an MRI contrast agent in this study. Forty-two children (7-18 years, 29 male, 13 female) received a 18F-FDG PET/MRI at 2 (n=20) or 24 hours (h) (n=22) after intravenous injection of ferumoxytol (dose 5 mg Fe/kg). The morphology of benign and malignant lymph nodes on ferumoxytol-enhanced T2-FSE sequences at 2 and 24 h were compared using a linear regression analysis. In addition, ADCmean-values, SUV-ratio (SUVmax lesion/SUVmean liver) and R2*-relaxation rate of benign and malignant lymph nodes were compared with a Mann-Whitney-U test. The accuracy of different criteria was assessed with a receiver operating characteristics (ROC) curve. Follow-up imaging for at least 6 months served as the standard of reference. Results: We examined a total of 613 lymph nodes, of which 464 (75.7%) were benign and 149 (24.3%) were malignant. On ferumoxytol-enhanced T2-FSE images, benign lymph nodes showed a hypointense hilum and hyperintense parenchyma, while malignant lymph nodes showed no discernible hilum. This pattern was not significantly different at 2 h and 24 h postcontrast (p=0.82). Benign and malignant lymph nodes showed significantly different ferumoxytol enhancement patterns, ADCmean values of 1578 and 852 x10-6 mm2/s, mean SUV-ratios of 0.5 and 2.8, and mean R2*-relaxation rate of 127.8 and 84.4 Hertz (Hz), respectively (all p90%) of ADCmean, SUV-ratio, pattern, and R2* measurements for the characterization of benign and malignant lymph nodes in children. Ferumoxytol nanoparticle accumulation at the hilum can be used to diagnose a benign lymph node. In the future, the delivery of clinically applicable nanoparticles to the hilum of benign lymph nodes could be harnessed to deliver theranostic drugs for immune cell priming.

10.7150/thno.40606https://pubmed.ncbi.nlm.nih.gov/32206111