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Song X, Zheng M, Hu H, Chen L, Wang S, Ding Z, Fu G, Sun L, Zhao L, Zhang L, Xu B, Qiu Y. Pharmacokinetic Study of Ultrasmall Superparamagnetic Iron Oxide Nanoparticles HY-088 in Rats. Eur J Drug Metab Pharmacokinet 2024:10.1007/s13318-024-00884-6. [PMID: 38393637 DOI: 10.1007/s13318-024-00884-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVE HY-088 injection is an ultrasmall superparamagnetic iron oxide nanoparticle (USPIOs) composed of iron oxide crystals coated with polyacrylic acid (PAA) on the surface. The purpose of this study was to investigate the pharmacokinetics, tissue distribution, and mass balance of HY-088 injection. METHODS The pharmacokinetics of [55Fe]-HY-088 and [14C]-HY-088 were investigated in 48 SD rats by intravenous injection of 8.5 (low-dose group), 25.5 (medium-dose group), and 85 (high-dose group) mg/100 μCi/kg. Tissue distribution was studied by intravenous injection of 35 mg/100 μCi/kg in 48 SD rats, and its tissue distribution in vivo was obtained by ex vivo tissue assay. At the same time, [14C]-HY-088 was injected intravenously at a dose of 25.5 mg/100 μCi/kg into 16 SD rats, and its tissue distribution in vivo was studied by quantitative whole-body autoradiography. [14C]-HY-088 and [55Fe]-HY-088 were injected intravenously into 24 SD rats at a dose of 35 mg/100 μCi/kg, and their metabolism was observed. RESULTS In the pharmacokinetic study, [55Fe]-HY-088 reached the maximum observed concentration (Cmax) at 0.08 h in the low- and medium-dose groups of SD rats. [14C]-HY-088 reached Cmax at 0.08 h in the three groups of SD rats. The area under the concentration-time curve (AUC) of [55Fe]-HY-088 and [14C]-HY-088 increased with increasing dose. In the tissue distribution study, [55Fe]-HY-088 and [14C]-HY-088 were primarily distributed in the liver, spleen, and lymph nodes of both female and male rats. In the mass balance study conducted over 57 days, the radioactive content of 55Fe from [55Fe]-HY-088 was primarily found in the carcass, accounting for 86.42 ± 4.18% in females and 95.46 ± 6.42% in males. The radioactive recovery rates of [14C]-HY-088 in the urine of female and male rats were 52.99 ± 5.48% and 60.66 ± 2.23%, respectively. CONCLUSIONS Following single intravenous administration of [55Fe]-HY-088 and [14C]-HY-088 in SD rats, rapid absorption was observed. Both [55Fe]-HY-088 and [14C]-HY-088 were primarily distributed in the liver, spleen, and lymph nodes. During metabolism, the radioactivity of [55Fe]-HY-088 is mainly present in the carcass, whereas the 14C-labeled [14C]-HY-088 shell PAA is eliminated from the body mainly through the urine.
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Affiliation(s)
- Xin Song
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Minglan Zheng
- Yangtze River Delta Center for Drug Evaluation and Inspection of NMPA, Shanghai, 201210, China
| | - Heping Hu
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Lei Chen
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Shuzhe Wang
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Zhao Ding
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Guangyi Fu
- Sichuan Huiyu Seacross Pharmaceutical,. Co. Ltd, Sichaun, 610021, China
| | - Luyao Sun
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Liyuan Zhao
- School of Pharmacy, Anhui University of Chinese Medicine, Hefei, 230013, China
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
- China Yangtze Delta Drug Advanced Research Institute, Nantong, 226133, China
| | - Ling Zhang
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China
| | - Bohua Xu
- InnoStar Bio-tech Nantong Co., Ltd., Nantong, 226133, China.
| | - Yunliang Qiu
- China State Institute of Pharmaceutical Industry, Shanghai InnorStar Biotech Co., Ltd., Shanghai, 201203, China.
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Zhang X, Liu M, Ren W, Sun J, Wang K, Xi X, Zhang G. Predicting of axillary lymph node metastasis in invasive breast cancer using multiparametric MRI dataset based on CNN model. Front Oncol 2022; 12:1069733. [PMID: 36561533 PMCID: PMC9763602 DOI: 10.3389/fonc.2022.1069733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose To develop a multiparametric MRI model for predicting axillary lymph node metastasis in invasive breast cancer. Methods Clinical data and T2WI, DWI, and DCE-MRI images of 252 patients with invasive breast cancer were retrospectively analyzed and divided into the axillary lymph node metastasis (ALNM) group and non-ALNM group using biopsy results as a reference standard. The regions of interest (ROI) in T2WI, DWI, and DCE-MRI images were segmented using MATLAB software, and the ROI was unified into 224 × 224 sizes, followed by image normalization as input to T2WI, DWI, and DCE-MRI models, all of which were based on ResNet 50 networks. The idea of a weighted voting method in ensemble learning was employed, and then T2WI, DWI, and DCE-MRI models were used as the base models to construct a multiparametric MRI model. The entire dataset was randomly divided into training sets and testing sets (the training set 202 cases, including 78 ALNM, 124 non-ALNM; the testing set 50 cases, including 20 ALNM, 30 non-ALNM). Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of models were calculated. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the diagnostic performance of each model for axillary lymph node metastasis, and the DeLong test was performed, P< 0.05 statistically significant. Results For the assessment of axillary lymph node status in invasive breast cancer on the test set, multiparametric MRI models yielded an AUC of 0.913 (95% CI, 0.799-0.974); T2WI-based model yielded an AUC of 0.908 (95% CI, 0.792-0.971); DWI-based model achieved an AUC of 0.702 (95% CI, 0.556-0.823); and the AUC of the DCE-MRI-based model was 0.572 (95% CI, 0.424-0.711). The improvement in the diagnostic performance of the multiparametric MRI model compared with the DWI and DCE-MRI-based models were significant (P< 0.01 for both). However, the increase was not meaningful compared with the T2WI-based model (P = 0.917). Conclusion Multiparametric MRI image analysis based on an ensemble CNN model with deep learning is of practical application and extension for preoperative prediction of axillary lymph node metastasis in invasive breast cancer.
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Affiliation(s)
- Xiaodong Zhang
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China,Postgraduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Menghan Liu
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Wanqing Ren
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China,Postgraduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Jingxiang Sun
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University, Jinan, China,Postgraduate Department, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan, China
| | - Kesong Wang
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, China
| | - Xiaoming Xi
- School of Computer Science and Technology, Shandong Jianzhu University, Jinan, China
| | - Guang Zhang
- Department of Health Management, The First Affiliated Hospital of Shandong First Medical University, Jinan, China,*Correspondence: Guang Zhang,
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Ren T, Lin S, Huang P, Duong TQ. Convolutional Neural Network of Multiparametric MRI Accurately Detects Axillary Lymph Node Metastasis in Breast Cancer Patients With Pre Neoadjuvant Chemotherapy. Clin Breast Cancer 2021; 22:170-177. [PMID: 34384696 DOI: 10.1016/j.clbc.2021.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/29/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Accurate assessment of the axillary lymph nodes (aLNs) in breast cancer patients is essential for prognosis and treatment planning. Current radiological staging of nodal metastasis has poor accuracy. This study aimed to investigate the machine learning convolutional neural networks (CNNs) on multiparametric MRI to detect nodal metastasis with 18FDG-PET as ground truths. MATERIALS AND METHODS Data were obtained via a retrospective search. Inclusion criteria were patients with bilateral breast MRI and 18FDG-PETand/or CT scans obtained before neoadjuvant chemotherapy. In total, 238 aLNs were obtained from 56 breast cancer patients with 18FDG-PET and/or CT and breast MRI data. Radiologists scored each node based on all MRI as diseased and non-diseased nodes. Five models were built using T1-W MRI, T2-W MRI, DCE MRI, T1-W + T2-W MRI, and DCE + T2-W MRI model. Performance was evaluated using receiver operating curve (ROC) analysis, including area under the curve (AUC). RESULTS All CNN models yielded similar performance with an accuracy ranging from 86.08% to 88.50% and AUC ranging from 0.804 to 0.882. The CNN model using T1-W MRI performed better than that using T2-W MRI in detecting nodal metastasis. CNN model using combined T1- and T2-W MRI performed the best compared to all other models (accuracy = 88.50%, AUC = 0.882), but similar in AUC to the DCE + T2-W MRI model (accuracy = 88.02%, AUC = 0.880). All CNN models performed better than radiologists in detecting nodal metastasis (accuracy = 65.8%). CONCLUSION xxxxxx.
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Affiliation(s)
- Thomas Ren
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Stephanie Lin
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Pauline Huang
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY
| | - Tim Q Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, New York, NY.
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Heeger AP, Ackman JB. Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions. Radiol Clin North Am 2021; 59:251-277. [PMID: 33551086 DOI: 10.1016/j.rcl.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The high soft tissue contrast and tissue characterization properties of magnetic resonance imaging allow further characterization of indeterminate mediastinal lesions on chest radiography and computed tomography, increasing diagnostic specificity, preventing unnecessary intervention, and guiding intervention or surgery when needed. The combination of its higher soft tissue contrast and ability to image dynamically during free breathing, without ionizing radiation exposure, allows more thorough and readily appreciable assessment of a lesion's invasiveness and assessment of phrenic nerve involvement, with significant implications for prognostic clinical staging and surgical management.
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Affiliation(s)
- Allen P Heeger
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jeanne B Ackman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Harvard Medical School, Massachusetts General Hospital, Founders House 202, 55 Fruit Street, Boston, MA 02114, USA.
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Mahieu R, de Maar JS, Nieuwenhuis ER, Deckers R, Moonen C, Alic L, ten Haken B, de Keizer B, de Bree R. New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12103055. [PMID: 33092093 PMCID: PMC7589685 DOI: 10.3390/cancers12103055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/03/2020] [Accepted: 10/15/2020] [Indexed: 12/18/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is a diagnostic staging procedure that aims to identify the first draining lymph node(s) from the primary tumor, the sentinel lymph nodes (SLN), as their histopathological status reflects the histopathological status of the rest of the nodal basin. The routine SLNB procedure consists of peritumoral injections with a technetium-99m [99mTc]-labelled radiotracer followed by lymphoscintigraphy and SPECT-CT imaging. Based on these imaging results, the identified SLNs are marked for surgical extirpation and are subjected to histopathological assessment. The routine SLNB procedure has proven to reliably stage the clinically negative neck in early-stage oral squamous cell carcinoma (OSCC). However, an infamous limitation arises in situations where SLNs are located in close vicinity of the tracer injection site. In these cases, the hotspot of the injection site can hide adjacent SLNs and hamper the discrimination between tracer injection site and SLNs (shine-through phenomenon). Therefore, technical developments are needed to bring the diagnostic accuracy of SLNB for early-stage OSCC to a higher level. This review evaluates novel SLNB imaging techniques for early-stage OSCC: MR lymphography, CT lymphography, PET lymphoscintigraphy and contrast-enhanced lymphosonography. Furthermore, their reported diagnostic accuracy is described and their relative merits, disadvantages and potential applications are outlined.
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Affiliation(s)
- Rutger Mahieu
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Josanne S. de Maar
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Eliane R. Nieuwenhuis
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Roel Deckers
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Chrit Moonen
- Division of Imaging and Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands; (J.S.d.M.); (R.D.); (C.M.)
| | - Lejla Alic
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bennie ten Haken
- Department of Magnetic Detection & Imaging, University of Twente, 7522 NB Enschede, The Netherlands; (E.R.N.); (L.A.); (B.t.H.)
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, University of Utrecht, 3584 CX Utrecht, The Netherlands;
- Correspondence: ; Tel.: +31-88-7550819
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Kim SH, Cho SH. Assessment of pelvic lymph node metastasis in FIGO IB and IIA cervical cancer using quantitative dynamic contrast-enhanced MRI parameters. Diagn Interv Radiol 2020; 26:382-389. [PMID: 32673204 DOI: 10.5152/dir.2020.19365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We prospectively determined whether the quantitative parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are useful for predicting pelvic lymph node (LN) status in cervical cancer through node-by-node pathologic validation of images. METHODS Overall, 182 LNs harvested from 200 consecutive patients with 2018 FIGO stage IB-IIA cervical cancer (82 metastatic and 100 nonmetastatic) were used for node-by-node assessment. Each LN was quantitatively assessed using Ktrans, Ve, and Kep values. The short-axis diameter, ratio of the long-axis to short-axis diameter, and long-axis diameter were also assessed. Data on metastatic LNs were divided into four groups according to the FIGO staging system. Receiver operating characteristic (ROC) curve analysis was performed to evaluate statistically significant parameters derived from DCE-MRI for the differentiation of metastatic LNs from nonmetastatic LNs. RESULTS The mean short-axis diameter of metastatic LNs was significantly larger than that of nonmetastatic LNs (all P < 0.05) despite several overlaps. In comparison with nonmetastatic LNs, metastatic LNs showed a significantly lower Ktrans (all P < 0.05); however, Kep and Ve were not significantly different (all P > 0.05). For IB3 and IIA2 cervical cancer, Ktrans had moderate diagnostic ability for differentiating metastatic LNs from nonmetastatic LNs (for IB3: area under the curve [AUC] 0.740, 95% CI 0.657-0.838, 61.7% sensitivity, 80.2% specificity, P = 0.007; for IIA2: AUC 0.786, 95% CI 0.650-0.846, 60.2% sensitivity, 81.8% specificity, P = 0.008). CONCLUSION Ktrans appears to be a useful parameter for detecting metastatic LNs, especially for IB3 and IIA2 cervical cancer.
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Affiliation(s)
- See Hyung Kim
- Departmet of Radiology, Kyungpook National University School of Medicine,, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Seung Hyun Cho
- Departmet of Radiology, Kyungpook National University School of Medicine,, Kyungpook National University Chilgok Hospital, Daegu, Korea
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Connolly S, Newport D, McGourty K. The mechanical responses of advecting cells in confined flow. BIOMICROFLUIDICS 2020; 14:031501. [PMID: 32454924 PMCID: PMC7200165 DOI: 10.1063/5.0005154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/21/2020] [Indexed: 05/03/2023]
Abstract
Fluid dynamics have long influenced cells in suspension. Red blood cells and white blood cells are advected through biological microchannels in both the cardiovascular and lymphatic systems and, as a result, are subject to a wide variety of complex fluidic forces as they pass through. In vivo, microfluidic forces influence different biological processes such as the spreading of infection, cancer metastasis, and cell viability, highlighting the importance of fluid dynamics in the blood and lymphatic vessels. This suggests that in vitro devices carrying cell suspensions may influence the viability and functionality of cells. Lab-on-a-chip, flow cytometry, and cell therapies involve cell suspensions flowing through microchannels of approximately 100-800 μ m. This review begins by examining the current fundamental theories and techniques behind the fluidic forces and inertial focusing acting on cells in suspension, before exploring studies that have investigated how these fluidic forces affect the reactions of suspended cells. In light of these studies' findings, both in vivo and in vitro fluidic cell microenvironments shall also be discussed before concluding with recommendations for the field.
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Affiliation(s)
- S Connolly
- School of Engineering, Bernal Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - D Newport
- School of Engineering, Bernal Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Horvat N, Carlos Tavares Rocha C, Clemente Oliveira B, Petkovska I, Gollub MJ. MRI of Rectal Cancer: Tumor Staging, Imaging Techniques, and Management. Radiographics 2019; 39:367-387. [PMID: 30768361 DOI: 10.1148/rg.2019180114] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Rectal cancer is prone to local recurrence and systemic metastasis. However, owing to improvements in TNM staging and treatment, including a more widespread use of rectal MRI and increased radiologist awareness of the key rectal cancer TNM staging features, the mortality rate of rectal cancer has been declining over the past few decades in adults over 50 years of age. Currently, rectal MRI plays a key role in the pre- and posttreatment evaluation of rectal cancer, assisting the multidisciplinary team in tailoring the most appropriate treatment option. The benefits achieved with rectal MRI are strictly dependent on obtaining good-quality images, which is important for the characterization of the main anatomic structures and their relationship with the tumor. In primary staging, rectal MRI helps the radiologist (a) describe the tumor location and morphology, (b) provide its T and N categories, (c) detect the presence of extramural vascular invasion, and (d) identify its relationship with surrounding structures, including the sphincter complex and involvement of the mesorectal fascia. These features help diagnose locally advanced rectal tumors (categories T3c-d, T4, N1, and N2), for which neoadjuvant chemoradiotherapy (CRT) is indicated. In restaging after neoadjuvant CRT, in addition to reassessing the features noted during primary staging, rectal MRI can help in the assessment of treatment response, especially with the emergence of nonsurgical approaches such as "watch and wait." ©RSNA, 2019.
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Affiliation(s)
- Natally Horvat
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Camila Carlos Tavares Rocha
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Brunna Clemente Oliveira
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Iva Petkovska
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
| | - Marc J Gollub
- From the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H., I.P., M.J.G.); Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, 01308-050 Bela Vista, São Paulo, Brazil (N.H., B.C.O.); and Department of Radiology, University of São Paulo, São Paulo, Brazil (N.H., C.C.T.R., B.C.O.)
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Role of Quantitative Dynamic Contrast-Enhanced MRI in Evaluating Regional Lymph Nodes With a Short-Axis Diameter of Less Than 5 mm in Rectal Cancer. AJR Am J Roentgenol 2018; 212:77-83. [PMID: 30354269 DOI: 10.2214/ajr.18.19866] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of this study was to discriminate metastatic from nonmetastatic regional lymph nodes (LNs) with short-axis diameters of less than 5 mm in rectal cancer using quantitative parameters derived from dynamic contrast-enhanced (DCE) MRI. SUBJECTS AND METHODS Sixty-five LNs from 122 patients were evaluated, including malignant LNs (n = 27) and benign LNs (n = 38). The following parameters were assessed: the forward volume transfer constant (Ktrans), reverse volume transfer constant (kep), fractional extravascular extracellular space volume (Ve), short-axis diameter, long-axis diameter, and short- to long-axis diameter ratio. ROC curves were used to analyze statistically significant parameters. RESULTS Metastatic LNs exhibited a lower Ktrans than did nonmetastatic LNs (p < 0.001), but the other parameters were not significantly different between the two groups. The AUC of the Ktrans was 0.732, with a 95% CI of 0.610-0.854, and the diagnostic cutoff value was 0.088 min-1 (sensitivity, 60.5%; specificity, 81.5%). CONCLUSION Ktrans had moderate diagnostic performance in assessing small regional LNs in rectal cancer and appears to be a useful predictor when distinguishing malignant LNs from benign LNs only by morphology is difficult.
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Chen Y, Yang X, Wen Z, Lu B, Xiao X, Shen B, Yu S. Fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI for predicting small node metastases in patients with rectal cancer. Cancer Imaging 2018; 18:21. [PMID: 29784058 PMCID: PMC5963161 DOI: 10.1186/s40644-018-0153-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
Background To investigate the application value of fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI in regional nodes with different short-axis diameter ranges in rectal cancer, especially in nodes ≤5 mm. Methods Patients with rectal adenocarcinoma confirmed by postoperative histopathology were included, and all the patients underwent preoperative 3.0 T rectal magnetic resonance imaging (MRI) and total mesorectal excision (TME) within 2 weeks after an MR scan. The harvested nodes from specimens were matched with nodes in the field of view (FOV) of images for a node-by-node evaluation. The maximum short-axis diameters of all the visible nodes in the FOV of images were measured by a radiologist; the morphological and enhancement characteristics of these nodes were also independently evaluated by two radiologists. The χ2 test was used to evaluate differences in morphological and enhancement characteristics between benign and malignant nodes. The enhancement characteristics were further compared between benign and malignant nodes with different short-axis diameter ranges using the χ2 test. Kappa statistics were used to describe interobserver agreement. Results A total of 441 nodes from 70 enrolled patients were included in the evaluation, of which 111 nodes were metastatic. Approximately 85.5 and 95.6% of benign nodes were found to have obvious enhancement and homogeneous or mild-heterogeneous enhancement, respectively, whereas approximately 89.2 and 85.1% of malignant nodes showed moderate or mild enhancement and obvious-heterogeneous or rim-like enhancement, respectively. The area under the receiver operating characteristic (ROC) curve (AUC) values of the enhancement degree for identifying the overall nodal status, nodes ≤5 mm and nodes > 5 mm and ≤ 10 mm were 0.887, 0.859 and 0.766 for radiologist 1 and 0.892, 0.823 and 0.774 for radiologist 2, respectively. The AUCs of enhancement homogeneity were 0.940, 0.928 and 0.864 for radiologist 1 and 0.944, 0.938 and 0.842 for radiologist 2, respectively. Nodal border and signal homogeneity were also of certain value in distinguishing metastatic nodes. Conclusions Enhancement characteristics based on fat-suppressed gadolinium-enhanced isotropic high-resolution 3D-GRE-T1WI were helpful for diagnosing metastatic nodes in rectal cancer and were a reliable indicator for nodes ≤5 mm.
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Affiliation(s)
- Yan Chen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xinyue Yang
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Ziqiang Wen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Baolan Lu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Xiaojuan Xiao
- Department of Radiology, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Bingqi Shen
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China
| | - Shenping Yu
- Department of Radiology, Sun Yat-sen University First Affiliated Hospital, Guangzhou, 510080, China.
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Bae S, Lee HJ, Nam W, Koh YW, Choi EC, Kim J. MR lymphography for sentinel lymph node detection in patients with oral cavity cancer: Preliminary clinical study. Head Neck 2018; 40:1483-1488. [PMID: 29633413 DOI: 10.1002/hed.25167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/03/2017] [Accepted: 01/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility of MR lymphography with interstitial injection of a gadolinium-based contrast agent for identifying sentinel lymph nodes in patients with oral cavity cancer and clinically negative neck. METHODS Pretreatment MR lymphography with a differential subsampling with cartesian ordering (DISCO) sequence was performed in 26 patients with resectable oral cavity cancer and clinically negative neck, after peritumoral injection of 1-mL diluted gadobutrol. The accuracy of sentinel lymph node identification by MR lymphography was assessed and compared with the final histopathological results. RESULTS The MR lymphography consistently visualized the 44 sentinel lymph nodes in all 26 patients. In all but 1 patient with pathologically positive neck, assumed sentinel lymph nodes revealed metastatic involvement. CONCLUSION Pretreatment MR lymphography is a safe and feasible imaging technique that can help clinicians identify sentinel lymph nodes with a high risk of occult metastases in patients with oral cavity cancer, enabling focused preoperative biopsy in these high-risk patients.
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Affiliation(s)
- Sohi Bae
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Joon Lee
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, Dental Hospital of Yonsei University of College of Dentistry, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jinna Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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International Multicenter Study on the Impact of Extracapsular Lymph Node Involvement in Primary Surgery Adenocarcinoma of the Esophagus on Overall Survival and Staging Systems. Ann Surg 2016; 262:809-15; discussion 815-6. [PMID: 26583670 DOI: 10.1097/sla.0000000000001463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The current pathological lymph node (pN) staging is based on the number of positive lymph nodes but does not take into consideration characteristics of the involved lymph nodes itself. The current study aims to examine the prognostic value of extracapsular lymph node involvement (EC-LNI) and intracapsular lymph node involvement (IC-LNI) for esophageal adenocarcinoma treated by primary surgery. METHODS From the databases of five European high volume centers, 1639 adenocarcinoma patients with primary R0-resection were withheld after excluding 90-day mortality. Oncologic variables, including number of resected lymph nodes, number of resected positive lymph nodes, and EC-LNI/IC-LNI were examined. The Union Internationale contre le Cancer (UICC) 7th edition prognostic staging was used as baseline staging system. Statistical analysis was performed by Cox proportional hazards modeling and verified using the Random Survival Forest technique. RESULTS EC-LNI showed significantly worse overall 5-year survival compared with IC-LNI overall (13.4% vs 37.2%, P < 0.0001), including in each pN-category [16.4% vs 45.6% in pN1 (P < 0.0001), 16.1% vs 23.8% (P = 0.047) in pN2 (P = 0.065), and 8.7% vs 26.3% in pN3 categories, respectively]. pN1 IC-LNI patients show a 5-year overall survival comparable (P = 0.92) with stage IIB (ie, pT3N0). Reclassifying the UICC prognostic stages according to these findings into an adapted staging model showed a significant (P < 0.0001) increase in homogeneity, discriminatory ability, and monotonicity compared with the original UICC TNM 7th edition prognostic staging. CONCLUSIONS These data suggest that lymph node capsular status is an important prognostic factor and should be considered for the future edition of the TNM staging system for esophageal cancer.
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García-Figueiras R, Padhani AR, Beer AJ, Baleato-González S, Vilanova JC, Luna A, Oleaga L, Gómez-Caamaño A, Koh DM. Imaging of Tumor Angiogenesis for Radiologists--Part 2: Clinical Utility. Curr Probl Diagn Radiol 2015; 44:425-36. [PMID: 25863438 DOI: 10.1067/j.cpradiol.2015.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 02/24/2015] [Accepted: 02/28/2015] [Indexed: 12/26/2022]
Abstract
Angiogenesis is a key cancer hallmark involved in tumor growth and metastasis development. Angiogenesis and tumor microenvironment significantly influence the response of tumors to therapies. Imaging techniques have changed our understanding of the process of angiogenesis, the resulting vascular performance, and the tumor microenvironment. This article reviews the status and potential clinical value of the imaging modalities used to assess the status of tumor vasculature in vivo, before, during, and after treatment.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England, UK
| | - Ambros J Beer
- Klinik für Nuklearmedizin, Universitätsklinikum Ulm; Ulm, Germany
| | - Sandra Baleato-González
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Joan C Vilanova
- Department of Radiology, Clínica Girona, IDI, University of Girona, Girona, Spain
| | - Antonio Luna
- Advanced Medical Imaging, Clinica Las Nieves, SERCOSA (Servicio Radiologia Computerizada), Grupo Health Time, Jaén, Spain; Department of Radiology, Case Western Reserve University, Cleveland, OH
| | - Laura Oleaga
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiotherapy, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Dow-Mu Koh
- Functional Imaging, Royal Marsden Hospital, Sutton, Surrey, England, UK
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Borra RJ, Cho HS, Bowen SL, Attenberger U, Arabasz G, Catana C, Josephson L, Rosen BR, Guimaraes AR, Hooker JM. Effects of ferumoxytol on quantitative PET measurements in simultaneous PET/MR whole-body imaging: a pilot study in a baboon model. EJNMMI Phys 2015; 2:6. [PMID: 26501808 PMCID: PMC4544618 DOI: 10.1186/s40658-015-0109-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/04/2015] [Indexed: 12/29/2022] Open
Abstract
Background Simultaneous PET/MR imaging depends on MR-derived attenuation maps (mu-maps) for accurate attenuation correction of PET data. Currently, these maps are derived from gradient-echo-based MR sequences, which are sensitive to susceptibility changes. Iron oxide magnetic nanoparticles have been used in the measurement of blood volume, tumor microvasculature, tumor-associated macrophages, and characterizing lymph nodes. Our aim in this study was to assess whether the susceptibility effects associated with iron oxide nanoparticles can potentially affect measured 18F-FDG PET standardized uptake values (SUV) through effects on MR-derived attenuation maps. Methods The study protocol was approved by the Institutional Animal Care and Use Committee. Using a Siemens Biograph mMR PET/MR scanner, we evaluated the effects of increasing concentrations of ferumoxytol and ferumoxytol aggregates on MR-derived mu-maps using an agarose phantom. In addition, we performed a baboon experiment evaluating the effects of a single i.v. ferumoxytol dose (10 mg/kg) on the liver, spleen, and pancreas 18F-FDG SUV at baseline (ferumoxytol-naïve), within the first hour and at 1, 3, 5, and 11 weeks. Results Phantom experiments showed mu-map artifacts starting at ferumoxytol aggregate concentrations of 10 to 20 mg/kg. The in vivo baboon data demonstrated a 53% decrease of observed 18F-FDG SUV compared to baseline within the first hour in the liver, persisting at least 11 weeks. Conclusions A single ferumoxytol dose can affect measured SUV for at least 3 months, which should be taken into account when administrating ferumoxytol in patients needing sequential PET/MR scans. Advances in knowledge 1. Ferumoxytol aggregates, but not ferumoxytol alone, produce significant artifacts in MR-derived attenuation correction maps at approximate clinical dose levels of 10 mg/kg. 2. When performing simultaneous whole-body 18F-FDG PET/MR, a single dose of ferumoxytol can result in observed SUV decreases up to 53%, depending on the amount of ferumoxytol aggregates in the studied tissue. Implications for patient care Administration of a single, clinically relevant, dose of ferumoxytol can potentially result in changes in observed SUV for a prolonged period of time in the setting of simultaneous PET/MR. These potential changes should be considered in particular when administering ferumoxytol to patients with expected future PET/MR studies, as ferumoxytol-induced SUV changes might interfere with therapy assessment. Electronic supplementary material The online version of this article (doi:10.1186/s40658-015-0109-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ronald Jh Borra
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA. .,Medical Imaging Centre of Southwest Finland, Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland.
| | - Hoon-Sung Cho
- Center for Advanced Medical Imaging Sciences, Massachusetts General Hospital, Charlestown, MA, USA. .,School of Materials Science and Engineering, Chonnam National University, Gwangju, South Korea.
| | - Spencer L Bowen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA.
| | - Ulrike Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
| | - Grae Arabasz
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA.
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA.
| | - Lee Josephson
- Center for Advanced Medical Imaging Sciences, Massachusetts General Hospital, Charlestown, MA, USA.
| | - Bruce R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA. .,Department of Meridian & Acupuncture, Collaborating Center for Traditional Medicine, East-West Medical Research Institute and School of Korean Medicine, Kyung Hee University, Seoul, South Korea.
| | - Alexander R Guimaraes
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA. .,Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jacob M Hooker
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th Street, Suite 2301, Charlestown, MA, 02129, USA.
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Schütz G, Lohrke J, Pietsch H. Lymph node staging using dedicated magnetic resonance contrast agents--the accumulation mechanism revisited. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2014; 7:238-49. [PMID: 25266498 DOI: 10.1002/wnan.1290] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 07/15/2014] [Accepted: 07/20/2014] [Indexed: 11/12/2022]
Abstract
When diagnosing cancer, assessing the nodal stage is tremendously important in determining the patient's prognosis. Computed tomography (CT) and magnetic resonance (MR) imaging (MRI) assessments of the regional lymph node (LN) size and shape are currently used for the initial nodal staging in clinical settings, although this approach has a rather low sensitivity, and biopsy often leads to restaging of the LNs. Acknowledging the great medical need to accurately stage LNs, scientists and clinicians have been working since the late 1980s on MR contrast agents that provide more reliable staging results. Different types of molecules (i.e., iron oxide nanoparticles and Gd-based contrast agent) have shown promising LN accumulation and imaging results, but no clinically approved, dedicated LN staging contrast agent is currently available. The literature describes a mechanism of contrast agent accumulation in the LNs that considers some but not all published experimental evidence. However, confidence in the mechanism of LN accumulation is a prerequisite for the directed synthesis of compounds for accurate and sensitive LN staging. To improve our understanding of the LN contrast agent accumulation mechanism, we reviewed the published data on the enrichment of colloidal MR contrast agent candidates in LNs, and we suggest an extended mechanism for contrast agent enrichment in LNs. For further clarification, physiology and results from drug targeting studies are considered where applicable.
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Detection of axillary lymph node metastasis with diffusion-weighted MR imaging. Clin Imaging 2014; 38:633-6. [DOI: 10.1016/j.clinimag.2014.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/26/2014] [Accepted: 04/23/2014] [Indexed: 02/06/2023]
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Li M, Kim HS, Tian L, Yu MK, Jon S, Moon WK. Comparison of Two Ultrasmall Superparamagnetic Iron Oxides on Cytotoxicity and MR Imaging of Tumors. Am J Cancer Res 2012; 2:76-85. [PMID: 22272221 PMCID: PMC3263518 DOI: 10.7150/thno.3462] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 11/04/2011] [Indexed: 12/03/2022] Open
Abstract
Purpose: This study was performed to compare the cytotoxicity and magnetic resonance (MR) contrast in diverse cultured cells and xenograft tumors models of two ultra-small superparamagnetic iron oxides (USPIOs), thermally cross-linked superparamagnetic iron oxide nanoparticles (TCL-SPION) and monocrystalline iron oxide nanoparticles (MION-47). Materials and methods: Transmission electron microscopy (TEM) images and R2 relaxivity values of the TCL-SPION and MION-47 were obtained and the cell viability and cell growth velocity of treated and untreated human fibroblasts and human umbilical vein endothelial cells (HUVEC) were evaluated. The effect of TCL-SPION and MION-47 on the secretion of interlukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), the production of nitric oxides and the mitochondrial membrane potentials in murine macrophage cells (RAW264.7) was compared. Human hepatocellular carcinoma cells (HepG2, 5x105) were subcutaneously injected into nude mice (BALB/c) and in vivo MR imaging of tumors before and after injection with TCL-SPION or MION-47 (12.5 mg Fe/kg) was performed on a 1.5 Tesla MRI scanner. Results: On TEM images, the average core diameter of TCL-SPION was 9 nm whereas that of MION-47 was 5 nm. TCL- SPION (345.0 ± 6.2 mM-1sec-1) had higher relaxivity (R2) than MION-47 (130.7 ± 1.1 mM-1sec-1). Significant changes in cell viability and growth were not found in human fibroblasts and HUVEC exposed to TCL-SPION and MION-47. However, IL-6 and TNF-α secretions increased dose-dependently and significantly in the macrophages treated with MION-47 or TCL-SPION. TCL-SPION had a lower stimulatory effect on IL-6 secretions than did MION-47 (P <0.05) and nitric oxides were produced in the macrophages by MION-47 but not TCL-SPION. A change in the mitochondrial membrane potential of the macrophages was observed 24 hours after the exposure, and MION-47 induced more collapses of the mitochondrial membrane potential than did TCL-SPION. In the in vivo MR imaging, 33.0 ± 1.3% and 7.5 ± 0.4% signal intensity decrease on T2*-weighted images was observed in the tumors injected with TCL-SPION and MION-47, respectively. Conclusion: Due to the modified surface properties and larger core size of its iron oxide nanoparticles, TCL-SPION achieves lower cytotoxicity and better tumor MR contrast than MION-47. Our study suggests that TCL-SPION may be used as a new platform for tumor imaging and therapy monitoring.
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Afaq A, Akin O. Imaging assessment of tumor response: past, present and future. Future Oncol 2011; 7:669-77. [PMID: 21568682 DOI: 10.2217/fon.11.38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Anatomical response assessment criteria have been in use for decades, with the WHO guidelines being replaced by Response Evaluation Criteria in Solid Tumors (RECIST), updated in 2009 to RECIST 1.1. These methods rely on a change in size of a tumor as the main response criteria, but newer cytostatic agents tend to target tumor function at a molecular level before changing the size of a lesion. Recent modifications, such as the Choi criteria, have improved assessment by taking into account density of tumor, but all of these criteria fail to utilize functional imaging parameters, which are becoming increasingly available, including perfusion CT, perfusion MRI, diffusion-weighted imaging, magnetic resonance spectroscopy, dynamic contrast-enhanced ultrasound and combined PET/computed tomography. Developments in these modalities and standardization of imaging acquisition will help to optimize the next set of response criteria, with inclusion of multiparametric, functional modalities, evaluating tumors at the same molecular level at which they are being targeted by therapeutic agents.
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Affiliation(s)
- Asim Afaq
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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