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Published on: March 31, 2008
Decrease of signal intensity of myometrium and cervical stroma after ultrasmall superparamagnetic iron oxide (USPIO)
Andrea Laghi1, Pasquale Paolantonio, Valeria Panebianco
1Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy. andrea.laghi@uniroma1.it
Objectives:
Following the empiric observation of a significant decrease of signal intensity of both myometrium and cervical stroma on ultrasmall superparamagnetic iron oxide (USPIO)-enhanced images, the aim of our study was to evaluate whether USPIO-enhanced T2*-weighted gradient echo (GRE) images might provide any potential advantage on T-staging of uterine malignancies having surgery and histology as standard of reference
Materials And Methods:
Seventeen female patients with known uterine malignancies underwent magnetic resonance (MR) imaging before and 24 hours after the intravenous administration of the USPIO agent. Imaging protocol included proton density-weighted turbo spin echo and T2*-weighted GRE sequences. Each patient underwent surgery within 14 days from the first MR examination, and histologic confirmation of tumor T-stage was obtained. Quantitative (calculation of signal-to-noise and contrast-to-noise ratios) and qualitative (visual assessment of T staging) analyses were performed on unenhanced and USPIO-enhanced images.
Results:
Quantitative analysis showed a significantly lower (P < 0.05) signal-to-noise ratio of myometrium and cervical stroma on USPIO-enhanced compared with unenhanced images. In 15 of 17 patients (88.2%), the contrast-to-noise ratio between tumor and myometrium and between tumor and cervical stroma was higher on USPIO-enhanced compared with unenhanced images (P < 0.001). Qualitative analysis demonstrated that the GRE T2* USPIO-enhanced MR offers a better definition of the depth of tumor infiltration rather than the unenhanced GRE T2* images.
Conclusion:
The decrease of signal intensity of myometrium and cervical stroma on T2*-weighted GRE images after the intravenous administration of USPIO should be considered a constant and physiologic finding that improves tumor conspicuity in the majority of the cases, allowing more accurate T-staging of neoplastic lesions.
Insights
Ultrasmall superparamagnetic iron oxide (USPIO) enhanced MRI improves uterine malignancy T-staging. USPIO-enhanced T2*-weighted images offer better tumor infiltration definition, leading to more accurate staging of neoplastic lesions.
Area of Science:
- Radiology
- Oncology
- Medical Imaging
Background:
- Uterine malignancies require accurate T-staging for treatment planning.
- Current MRI techniques may have limitations in defining tumor infiltration depth.
- Ultrasmall superparamagnetic iron oxide (USPIO) is an MRI contrast agent.
Purpose of the Study:
- To evaluate the potential advantage of USPIO-enhanced T2*-weighted gradient echo (GRE) magnetic resonance (MR) images for T-staging of uterine malignancies.
- To compare USPIO-enhanced images with unenhanced images for diagnostic accuracy.
Main Methods:
- Seventeen female patients with uterine malignancies underwent MR imaging before and after USPIO administration.
- Imaging included proton density-weighted turbo spin echo and T2*-weighted GRE sequences.
- Quantitative and qualitative analyses were performed, with surgery and histology as the standard of reference.
Main Results:
- USPIO-enhanced images showed significantly lower signal-to-noise ratios in the myometrium and cervical stroma (P < 0.05).
- Contrast-to-noise ratios between tumor and surrounding tissues were significantly higher on USPIO-enhanced images (P < 0.001).
- Qualitative analysis revealed better definition of tumor infiltration depth on USPIO-enhanced GRE T2* images.
Conclusions:
- The signal decrease in myometrium and cervical stroma after USPIO administration is a consistent physiologic finding.
- USPIO-enhanced T2*-weighted GRE MR imaging improves tumor conspicuity.
- This technique allows for more accurate T-staging of uterine neoplastic lesions.
