磁共振间质淋巴造影诊断前列腺癌盆腔淋巴结转移的安全性和可行性研究

The safety and feasibility of interstitial MR lymphography using gadodiamide injection for the diagnosis of pelvic lymph node metastasis in patients with prostate cancer

目的评估欧乃影介导的磁共振间质淋巴造影诊断前列腺癌盆腔淋巴结转移的可行性和安全性。方法对30例确诊为前列腺癌的患者于双侧腹股沟及阴囊根部皮下真皮层内注射欧乃影,通过三维增强磁共振淋巴造影增强扫描,采用兴趣区法测量造影后各组淋巴结的信号强度,绘制不同延迟时间引流区域淋巴结信号强度的时间-信号强度曲线,定性和定量分析以评估淋巴管及淋巴结增强造影效果。结果皮下注射欧乃影后,欧乃影迅速吸收进入淋巴系统,引流区域各组淋巴结显示清晰。皮下注射对比剂9min后腹股沟淋巴结信号强度达到峰值,而髂内、外淋巴结则于注射后11min达到最大信号强度;各组淋巴结间的峰值信号强度有明显差异。常规MRI扫描辨认淋巴结19枚,欧乃影静脉注射增强扫描辨认淋巴结21枚,磁共振间质淋巴造影共辨认淋巴结162枚。常规扫描辨认可疑转移淋巴结6枚,欧乃影静脉注射增强扫描辨认可疑转移淋巴结6枚,磁共振间质淋巴造影辨认可疑转移淋巴结26枚。常规和增强磁共振不能检出的<1.0cm的转移淋巴结可通过磁共振间质淋巴造影检出。结论经腹股沟及阴囊根部皮下注射欧乃影磁共振间质淋巴造影术诊断前列腺癌盆腔淋巴结转移安全、可行,该注射途径对盆腔淋巴结的显影更加全面。

Objective To evaluate the feasibility and safety of interstitial MRI lymphography using Gadodiamide injection for diagnosis of lymph node metastasis in patients with prostate cancer. Methods Interstitial MRI lymphography were performed on 30 patients with prostate cancer. Gadodiamide were injected cutaneously into the inguen and the base of scrotum bilaterally. All of the MRI examinations were performed on 3D MRI lymphography after intracutaneous administration of gadodiamide. Signal intensity measurements in regions of interest area encompassing the entire lymph node were used to calculate each node. The signal intensity of the regional lymph nodes were qualitatively assessed by the time-signal curve and statistical analysis. Enhancement effect of lymphatic vessels and nodes were evaluated by qualitative and quantitative. Results Lymph node groups became visible following subcutaneous injection of Gadodiamide injection. Inguinal and iliacal lymph nodes demonstrated signal peaks 9, 11 minutes after Gadodiamide application subcutaneouly. 19 lymph nodes were visualized with conventional MRI, including 6 tumor-invaded nodes; 21 lymph nodes were visualized with contrast-enhanced MR, including 6 tumor-invaded nodes; 162 lymph nodes were visualizedwith 3D contrast-enhanced interstitial MR lymphography, including 26 tumor-invaded nodes. Metastatic lymph nodes with the maximum diatmeter of 1.0 cm detected in 3D CE-MRL was not shown by conventional and contance-enhanced MRI seaning. Conclusions Interstitial MR lymphography using Gadodiamide injection in the inguen and the base of scrotum for lymph node metastasis in patients with prostate cancer is safe and pelvic lymph node could be shown widely and more completely.