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Molloi S, Polivka AR, Zhao Y, Redmond J, Itkin M, Antunes I, Yu Z. Dynamic Contrast-enhanced CT Lymphangiography to Quantify Thoracic Duct Lymphatic Flow. Radiology 2023; 309:e230959. [PMID: 38112547 DOI: 10.1148/radiol.230959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background CT lymphangiography has been used to image the lymphatic anatomy and assess lymphatic abnormalities. There is, however, a need to develop a method for quantification of lymphatic flow rate in the thoracic duct (TD). Purpose To develop and validate a TD lymphatic flow measurement technique using dynamic contrast-enhanced CT lymphangiography. Materials and Methods Lymphatic flow rate was measured with two techniques: a first-pass analysis technique based on a single compartment model and a thresholding technique distinguishing between opacified and nonopacified voxels within the TD. The measurements were validated in a swine animal model between November 2021 and September 2022. CT images were acquired at 100 kV and 200 mA using a fast-pitched helical scan mode covering the entire TD following contrast material injection into the bilateral inguinal lymph nodes. Two helical CT scans, acquired at the base and peak contrast enhancement of the TD, were used to measure lymphatic flow rate. A US flow probe surgically placed around the TD provided the reference standard measurement. CT lymphatic flow measurements were compared with the reference US flow probe measurements using regression and Bland-Altman analysis. Repeatability was determined using repeated flow measurements within approximately 10 minutes of each other. Results Eleven swine (10 male; mean weight, 43.6 kg ± 2.6 [SD]) were evaluated with 71 dynamic CT acquisitions. The lymphatic flow rates measured using the first-pass analysis and thresholding techniques were highly correlated with the reference US flow probe measurements (r = 0.99 and 0.91, respectively) and showed good agreement with the reference standard, with Bland-Altman analysis showing small mean differences of 0.04 and 0.05 mL/min, respectively. The first-pass analysis and thresholding techniques also showed good agreement for repeated flow measurements (r = 0.94 and 0.90, respectively), with small mean differences of 0.09 and 0.03 mL/min, respectively. Conclusion The first-pass analysis and thresholding techniques could be used to accurately and noninvasively quantify TD lymphatic flow using dynamic contrast-enhanced CT lymphangiography. © RSNA, 2023 See also the editorial by Choyke in this issue.
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Affiliation(s)
- Sabee Molloi
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Alesh R Polivka
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Yixiao Zhao
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Jonas Redmond
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Maxim Itkin
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Ines Antunes
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
| | - Zhaoxia Yu
- From the Departments of Radiological Sciences (S.M., A.R.P., Y.Z., I.A.) and Statistics (Z.Y.), University of California Irvine, Medical Sciences I, B-140, Irvine, CA 92697; Department of Radiological Sciences, University of California San Diego, San Diego, Calif (J.R.); and Department of Radiology, University of Pennsylvania, Philadelphia, Pa (M.I.)
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Lymph Node Metastases Detection Using Gd 2O 3@PCD as Novel Multifunctional Contrast Imaging Agent in Metabolic Magnetic Resonance Molecular Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5425851. [PMID: 36304774 PMCID: PMC9581618 DOI: 10.1155/2022/5425851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/26/2023]
Abstract
Axillary lymph node detection is crucial to staging and prognosis of the lymph node metastatic spread in breast cancer. Currently, lymphoscintigraphy and blue dye, as the conventional methods to localize sentinel lymph nodes (SLNs), are invasive and can only be performed during surgery. This study has had a novel hybrid gadolinium oxide nanoparticle coating with Cyclodextrin-based polyester as a high-relaxivity T1 magnetic resonance molecular imaging (MRMI) contrast agent (CA). Twelve female BALB/c mice were randomly divided into three groups of four mice; each group was injected with 4T1 cells to obtain metastasis lymph nodes and diagnosed by using the 3D T1W (VIBE) MRI (Siemens 3T, Prisma). The synthesized Gd2O3@PCD nanoparticles with a suitable particle size range of 20-40 nm have had much higher longitudinal relaxivity (r 1) for Gd2O3@PCD and Gd-DOTA (Dotarem) with the values of 3.98 mM-1·s-1 ± 0.003 and 2.71 mM-1·s-1 ± 0.005, respectively. Identical MR images in coronal views were subsequently obtained to create time-intensity curves of the right axillary lymph nodes and to measure the contrast ratio (CR). The peak CR and qualitative assessment of axillary lymph nodes at five-time points were evaluated. After subcutaneous injection, the contrast ratio of axillary lymph node and tumor in mice exhibited CR peak of Gd2O3@PCD and Dotarem with the values of 2.21 ± 0.06 and 0.40 ± 0.004 for lymph node and 2.54 ± 0.04 and 1.21 ± 0.007 for the tumor, respectively. Furthermore, the lumbar-aortic lymph node is weakly visible in the original coronal image. In conclusion, the use of Gd2O3@PCD nanoparticles as novel MRMI CAs enables high resolution for the detection of lymph node metastasis in mice with the potential capability for breast cancer diagnostic imaging.
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Lee SH, Hong JP. MR Lymphangiography. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:70-80. [PMID: 36238120 PMCID: PMC9432101 DOI: 10.3348/jksr.2020.81.1.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 07/07/2020] [Accepted: 01/14/2020] [Indexed: 12/03/2022]
Abstract
림프부종의 수술적 치료는 최근 늘어나고 있으며 그에 따른 림프관 평가를 위해 자기공명영상 획득이 증가하고 있다. 전통적인 T2 강조영상에서부터 삼차원 영상에 이르기까지 많은 발전이 이루어지고 있는 분야이다. 삼차원 영상으로는 spoiled gradient echo 영상이 있고 그 변형기법들이 시행되고 있으며 영상에 필수적인 지방억제기법은 최근 mDixon 기법이 각광받고 있다.
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Affiliation(s)
- Sang Hoon Lee
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Novel Hybrid Dextran-Gadolinium Nanoparticles as High-relaxivity T1 Magnetic Resonance Imaging Contrast Agent for Mapping the Sentinel Lymph Node. J Comput Assist Tomogr 2019; 43:350-357. [PMID: 30875338 DOI: 10.1097/rct.0000000000000842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To assess the applicability of a novel hybrid dextran-gadolinium nanoparticles (NPs) as high-relaxivity T1 magnetic resonance imaging (MRI) contrast agent for mapping the sentinel lymph node (SLN). METHODS Dextran-bis-acrylamide-polyacrylic acid (Dex-MBA-PAA) NPs were synthesized through a self-assembly assisted approach and complexed with multiple chelated gadolinium (Gd) (III) ions. After their characterization was validated, they were used to mapping SLNs by MRI in Wistar rats, and their biosafety was evaluated. RESULTS Dextran-MBA-polyacrylic acid-Gd NPs have suitable particle size and much higher longitudinal relaxivity (r1) than that of commonly used clinical MRI contrast agents (eg, gadopentetic acid dimeglumine salt injection). The in vivo T1-weighted MRI results revealed their effectiveness at mapping SLNs. And their biological safety was also verified. CONCLUSIONS Dextran-MBA-polyacrylic acid-Gd NPs were synthesized and validated by in vitro and in vivo experiments for their ability to visualize SLNs by MRI with accurate positioning and excellent biosafety, and they have great potential for clinical SLN mapping.
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Magnetic Resonance Lymphography at 9.4 T Using a Gadolinium-Based Nanoparticle in Rats: Investigations in Healthy Animals and in a Hindlimb Lymphedema Model. Invest Radiol 2018; 52:725-733. [PMID: 28678084 DOI: 10.1097/rli.0000000000000398] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Magnetic resonance lymphography (MRL) in small animals is a promising but challenging tool in preclinical lymphatic research. In this study, we compared the gadolinium (Gd)-based nanoparticle AGuIX with Gd-DOTA for interstitial MRL in healthy rats and in a chronic rat hindlimb lymphedema model. MATERIALS AND METHODS A comparative study with AGuIX and Gd-DOTA for interstitial MRL was performed in healthy Lewis rats (n = 6). For this purpose, 75 μL of 3 mM AGuIX (containing 30 mM Gd-DOTA side residues) and 75 μL 30 mM Gd-DOTA were injected simultaneously in the right and left hindlimbs. Repetitive high-resolution, 3-dimensional time-of-flight gradient recalled echo MRL sequences were acquired over a period of 90 minutes using a 9.4 T animal scanner. Gadofosveset-enhanced MR angiography and surgical dissection after methylene blue injection served as supportive imaging techniques. In a subsequent proof-of-principle study, AGuIX-based MRL was investigated in a hindlimb model of chronic lymphedema (n = 4). Lymphedema of the right hindlimbs was induced by means of popliteal and inguinal lymphadenectomy and irradiation with 20 Gy. The nonoperated left hindlimbs served as intraindividual controls. Six, 10, and 14 weeks after lymphadenectomy, MRL investigations were performed to objectify lymphatic reorganization. Finally, skin samples of the lymphedematous and the contralateral control hindlimbs were analyzed by means of histology and immunohistochemistry. RESULTS AGuIX-based MRL resulted in high-resolution anatomical depiction of the rodent hindlimb lymphatic system. Signal-to-noise ratio and contrast-to-noise ratio of the popliteal lymph node were increased directly after injection and remained significantly elevated for up to 90 minutes after application. AGuIX provided significantly higher and prolonged signal intensity enhancement as compared with Gd-DOTA. Furthermore, AGuIX-based MRL demonstrated lymphatic regeneration in the histopathologically verified chronic lymphedema model. Collateral lymphatic vessels were detectable 6 weeks after lymphadenectomy. CONCLUSIONS This study demonstrates that AGuIX is a suitable contrast agent for preclinical interstitial MRL in rodents. AGuIX yields anatomical imaging of lymphatic vessels with diameters greater than 200 μm. Moreover, it resides in the lymphatic system for a prolonged time. AGuIX may therefore facilitate high-resolution MRL-based analyses of the lymphatic system in rodents.
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Turkbey B, Hoyt RF, Agarwal HK, Bernardo M, Sankineni S, Johnson L, Grant KB, Rais-Bahrami S, Kobayashi H, Wood BJ, Pinto PA, Griffiths GL, Choyke PL. Magnetic resonance sentinel lymph node imaging of the prostate with gadofosveset trisodium-albumin: preliminary results in a canine model. Acad Radiol 2015; 22:646-52. [PMID: 25683498 PMCID: PMC4395526 DOI: 10.1016/j.acra.2014.12.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/31/2014] [Accepted: 12/31/2014] [Indexed: 11/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if intraprostatic injection of gadofosveset trisodium mixed with human serum albumin (HSA) can identify sentinel lymph nodes (LNs) draining the prostate on magnetic resonance imaging (MRI) in a canine model. MATERIALS AND METHODS Three male canines weighing between 25.7 and 41.3 kg were anesthetized, placed in a 3-T MRI, and a needle was placed transrectally into one side of the prostate using a commercially available intrarectal needle guide. Gadofosveset trisodium premixed with 10% HSA was then administered at doses ranging from 0.1 to 2.5 mL. T1W MRI was performed immediately after injection, and two readers evaluated images for visualization of LNs draining the prostate. RESULTS Intraprostatic injection of 0.2 mL gadofosveset trisodium premixed with HSA identified the draining periprostatic LNs in all cases. Delayed images demonstrated upper echelon nodes in the pelvis and the abdomen. Higher volume injections resulted in excessive periprostatic extravasation, whereas lower volume injections resulted in suboptimal visualization of LNs. CONCLUSIONS We demonstrate that gadofosveset trisodium (premixed with 10% HSA) injected intraprostatically at 0.2 mL visualized LNs draining the prostate. This approach can be readily adapted for clinical applications such as sentinel LN imaging in prostate cancer patients before surgery.
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Affiliation(s)
- Baris Turkbey
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088.
| | - Robert F Hoyt
- Laboratory of Animal Medicine and Surgery NHLBI, NIH, Bethesda, Maryland; Laboratory Animal Science Program, Leidos Biomedical Research Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Harsh K Agarwal
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Philips Research North America, Briarcliff Manor, New York
| | - Marcelino Bernardo
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088; Laboratory Animal Science Program, Leidos Biomedical Research Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Sandeep Sankineni
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088
| | - Linda Johnson
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088
| | - Kinzya B Grant
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088
| | | | - Hisataka Kobayashi
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088
| | - Bradford J Wood
- Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland
| | - Peter A Pinto
- Urologic Oncology Branch, NCI, NIH, Bethesda, Maryland; Center for Interventional Oncology, NCI and Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland
| | - Gary L Griffiths
- Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research Inc. (formerly SAIC-Frederick, Inc.), Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Peter L Choyke
- Molecular Imaging Program, NCI, NIH, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85, Bethesda, MD 20892-1088
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Mitsumori LM, McDonald ES, Wilson GJ, Neligan PC, Minoshima S, Maki JH. Mr lymphangiography: How i do it. J Magn Reson Imaging 2015; 42:1465-77. [DOI: 10.1002/jmri.24887] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 11/21/2014] [Indexed: 02/04/2023] Open
Affiliation(s)
- Lee M. Mitsumori
- Department of Radiology; Straub Clinic and Hospital; Honolulu Hawaii USA
| | | | - Gregory J. Wilson
- Department of Radiology; University of Washington; Seattle Washington USA
| | - Peter C. Neligan
- Department of Plastic Surgery; University of Washington; Seattle Washington USA
| | - Satoshi Minoshima
- Department of Radiology; University of Washington; Seattle Washington USA
| | - Jeffrey H. Maki
- Department of Radiology; University of Washington; Seattle Washington USA
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Niu G, Chen X. Lymphatic imaging: focus on imaging probes. Am J Cancer Res 2015; 5:686-97. [PMID: 25897334 PMCID: PMC4402493 DOI: 10.7150/thno.11862] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 01/10/2023] Open
Abstract
In view of the importance of sentinel lymph nodes (SLNs) in tumor staging and patient management, sensitive and accurate imaging of SLNs has been intensively explored. Along with the advance of the imaging technology, various contrast agents have been developed for lymphatic imaging. In this review, the lymph node imaging agents were summarized into three groups: tumor targeting agents, lymphatic targeting agents and lymphatic mapping agents. Tumor targeting agents are used to detect metastatic tumor tissue within LNs, lymphatic targeting agents aim to visualize lymphatic vessels and lymphangionesis, while lymphatic mapping agents are mainly for SLN detection during surgery after local administration. Coupled with various signal emitters, these imaging agents work with single or multiple imaging modalities to provide a valuable way to evaluate the location and metastatic status of SLNs.
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Ruddell A, Kirschbaum SB, Ganti SN, Liu CL, Sun RR, Partridge SC. Tumor-induced alterations in lymph node lymph drainage identified by contrast-enhanced MRI. J Magn Reson Imaging 2014; 42:145-52. [PMID: 25256593 DOI: 10.1002/jmri.24754] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/27/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To use high resolution MRI lymphography to characterize altered tumor-draining lymph node (TDLN) lymph drainage in response to growth of aggressive tumors. METHODS Six mice bearing B16-F10 melanomas in one rear footpad were imaged by 3.0 Tesla (T) MRI before and after subcutaneous injection of Gadofosveset trisodium (Gd-FVT) contrast agent into both rear feet. Gd-FVT uptake into the left and right draining popliteal LNs was quantified and compared using Wilcoxon signed-rank test. Fluorescent dextran lymphography compared patterns of LN lymph drainage with the pattern of immunostained lymphatic sinuses by fluorescence microscopy. RESULTS TDLNs exhibited greater Gd-FVT uptake than contralateral uninvolved LNs, although this difference did not reach significance (P < 0.06). Foci of contrast agent consistently surrounded the medulla and cortex of TDLNs, while Gd-FVT preferentially accumulated in the cortex of contralateral LNs at 5 and 15 min after injection. Fluorescent dextran lymphography confirmed these distinct contrast agent uptake patterns, which correlated with lymphatic sinus growth in TDLNs. CONCLUSION 3.0T MRI lymphography using Gd-FVT identified several distinctive alterations in the uptake of contrast agent into TDLNs, which could be useful to identify the correct TDLN, and to characterize TDLN lymphatic sinus growth that may predict metastatic potential.
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Affiliation(s)
- Alanna Ruddell
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Comparative Medicine, University of Washington, Seattle, WA, USA
| | | | - Sheila N Ganti
- Department of Comparative Medicine, University of Washington, Seattle, WA, USA
| | | | - Ryan R Sun
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Savannah C Partridge
- Seattle Cancer Care Alliance, Seattle, WA, USA.,Department of Radiology, University of Washington, Seattle, WA, USA
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