Universität zu Köln

Muehe, Anne Monika, Siedek, Florian, Theruvath, Ashok Joseph, Seekins, Jayne, Spunt, Sheri L., Pribnow, Allison, Hazard, Florette Kimberly, Liang, Tie and Daldrup-Link, Heike (2020). Differentiation of benign and malignant lymph nodes in pediatric patients on ferumoxytol-enhanced PET/MRI. Theranostics, 10 (8). S. 3612 - 3622. LAKE HAVEN: IVYSPRING INT PUBL. ISSN 1838-7640

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Abstract

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 F-18-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 F-18-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 F-18-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) mm(2)/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 p<0.001). The accuracy of ADCmean, SUV-ratio and pattern (area under the curve (AUC): 0.99; 0.98; 0.97, respectively) was not significantly different (p=0.07). Compared to these three parameters, the accuracy of R2* was significantly lower (AUC: 0.93; p=0.001). Conclusion: Lymph nodes in children show different ferumoxytol-enhancement patterns on MRI than previously reported for adult patients. We found high accuracy (>90%) 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Muehe, Anne Monika UNSPECIFIED UNSPECIFIED UNSPECIFIED Siedek, Florian UNSPECIFIED UNSPECIFIED UNSPECIFIED Theruvath, Ashok Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED Seekins, Jayne UNSPECIFIED UNSPECIFIED UNSPECIFIED Spunt, Sheri L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pribnow, Allison UNSPECIFIED UNSPECIFIED UNSPECIFIED Hazard, Florette Kimberly UNSPECIFIED UNSPECIFIED UNSPECIFIED Liang, Tie UNSPECIFIED UNSPECIFIED UNSPECIFIED Daldrup-Link, Heike UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-351314
DOI:	10.7150/thno.40606
Journal or Publication Title:	Theranostics
Volume:	10
Number:	8
Page Range:	S. 3612 - 3622
Date:	2020
Publisher:	IVYSPRING INT PUBL
Place of Publication:	LAKE HAVEN
ISSN:	1838-7640
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ULTRASMALL SUPERPARAMAGNETIC PARTICLES; INITIAL EVALUATION; PROSTATE-CANCER; FDG PET/CT; METASTASES; SARCOMA; BLADDER; DISEASE; AGE; MRI Multiple languages Medicine, Research & Experimental Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/35131