Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA: Surgical correlation in early recurrence

Binor Said, J. Andrea McCart, Steven K. Libutti, Peter L. Choyke

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

The purpose of this study was to evaluate the value of Ferumoxide- enhanced magnetic resonance (MR) imaging in the detection of hepatic metastases in high-risk patients treated for colorectal cancer that have rising CEA. We used 19 patients treated previously for colorectal cancer with rising CEA levels underwent an unenhanced T1-weighted (T1W), T2-weighted (T2W), STIR, and Ferumoxide-enhanced hepatic MRI. Following these studies, a laparotomy was performed and the liver was evaluated by palpation and intraoperative ultrasound. Two observers who were blinded to surgical results evaluated each MR sequence separately. The number of lesions considered highly suspicious for metastatic lesions were determined for each sequence and were compared to the results of surgery. The McNemar test was used to compare the outcomes of the different sequences. MR Imaging was unable to detect small (<5 mm) metastases discovered at surgery. The best non-contrast sequences for detecting metastases were the STIR with 42% sensitivity, 83% specificity and an overall accuracy of 56% and the T1W sequence (sensitivity 38%, specificity 100%, accuracy 57%), which were not significantly different (p > 0.4). The noncontrast T2W sequence had a sensitivity of 29% and a specificity of 77% with an overall accuracy of 46%. When all pre contrast scans were grouped together the common sensitivity was 42%, specificity was 77% and accuracy was 54%. The post-ferumoxide T2W scans had a sensitivity of 42%, specificity of 85%, and accuracy of 57%, but did not detect any additional lesions. There was no statistical difference between the pre- and post-contrast studies with regard to identifying patients with metastatic disease (p > 0.1). In conclusion, we found small hepatic metastases in patients with early signs of recurrent colorectal cancer are difficult to detect on MRI. Ferumoxide-enhanced MRI was unable to detect additional hepatic metastases and performed no better than unenhanced MRI in detecting small hepatic metastasis. (C) 2000 Elsevier Science Inc.

Original languageEnglish (US)
Pages (from-to)305-309
Number of pages5
JournalMagnetic Resonance Imaging
Volume18
Issue number3
DOIs
StatePublished - Apr 2000
Externally publishedYes

Fingerprint

metastasis
Magnetic resonance imaging
Colorectal Neoplasms
Magnetic resonance
cancer
lesions
magnetic resonance
Recurrence
Liver
Neoplasm Metastasis
sensitivity
Imaging techniques
Magnetic Resonance Imaging
liver
surgery
Surgery
Palpation
Ultrasonics
Laparotomy
ferumoxides

Keywords

  • Ferumoxide
  • Liver
  • Metastases

ASJC Scopus subject areas

  • Biophysics
  • Clinical Biochemistry
  • Structural Biology
  • Radiology Nuclear Medicine and imaging
  • Condensed Matter Physics

Cite this

Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA : Surgical correlation in early recurrence. / Said, Binor; McCart, J. Andrea; Libutti, Steven K.; Choyke, Peter L.

In: Magnetic Resonance Imaging, Vol. 18, No. 3, 04.2000, p. 305-309.

Research output: Contribution to journalArticle

Said, Binor ; McCart, J. Andrea ; Libutti, Steven K. ; Choyke, Peter L. / Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA : Surgical correlation in early recurrence. In: Magnetic Resonance Imaging. 2000 ; Vol. 18, No. 3. pp. 305-309.
@article{395c1ec77b3c488bb5434d82c5ee781c,
title = "Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA: Surgical correlation in early recurrence",
abstract = "The purpose of this study was to evaluate the value of Ferumoxide- enhanced magnetic resonance (MR) imaging in the detection of hepatic metastases in high-risk patients treated for colorectal cancer that have rising CEA. We used 19 patients treated previously for colorectal cancer with rising CEA levels underwent an unenhanced T1-weighted (T1W), T2-weighted (T2W), STIR, and Ferumoxide-enhanced hepatic MRI. Following these studies, a laparotomy was performed and the liver was evaluated by palpation and intraoperative ultrasound. Two observers who were blinded to surgical results evaluated each MR sequence separately. The number of lesions considered highly suspicious for metastatic lesions were determined for each sequence and were compared to the results of surgery. The McNemar test was used to compare the outcomes of the different sequences. MR Imaging was unable to detect small (<5 mm) metastases discovered at surgery. The best non-contrast sequences for detecting metastases were the STIR with 42{\%} sensitivity, 83{\%} specificity and an overall accuracy of 56{\%} and the T1W sequence (sensitivity 38{\%}, specificity 100{\%}, accuracy 57{\%}), which were not significantly different (p > 0.4). The noncontrast T2W sequence had a sensitivity of 29{\%} and a specificity of 77{\%} with an overall accuracy of 46{\%}. When all pre contrast scans were grouped together the common sensitivity was 42{\%}, specificity was 77{\%} and accuracy was 54{\%}. The post-ferumoxide T2W scans had a sensitivity of 42{\%}, specificity of 85{\%}, and accuracy of 57{\%}, but did not detect any additional lesions. There was no statistical difference between the pre- and post-contrast studies with regard to identifying patients with metastatic disease (p > 0.1). In conclusion, we found small hepatic metastases in patients with early signs of recurrent colorectal cancer are difficult to detect on MRI. Ferumoxide-enhanced MRI was unable to detect additional hepatic metastases and performed no better than unenhanced MRI in detecting small hepatic metastasis. (C) 2000 Elsevier Science Inc.",
keywords = "Ferumoxide, Liver, Metastases",
author = "Binor Said and McCart, {J. Andrea} and Libutti, {Steven K.} and Choyke, {Peter L.}",
year = "2000",
month = "4",
doi = "10.1016/S0730-725X(99)00134-4",
language = "English (US)",
volume = "18",
pages = "305--309",
journal = "Magnetic Resonance Imaging",
issn = "0730-725X",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Ferumoxide-enhanced MRI in patients with colorectal cancer and rising CEA

T2 - Surgical correlation in early recurrence

AU - Said, Binor

AU - McCart, J. Andrea

AU - Libutti, Steven K.

AU - Choyke, Peter L.

PY - 2000/4

Y1 - 2000/4

N2 - The purpose of this study was to evaluate the value of Ferumoxide- enhanced magnetic resonance (MR) imaging in the detection of hepatic metastases in high-risk patients treated for colorectal cancer that have rising CEA. We used 19 patients treated previously for colorectal cancer with rising CEA levels underwent an unenhanced T1-weighted (T1W), T2-weighted (T2W), STIR, and Ferumoxide-enhanced hepatic MRI. Following these studies, a laparotomy was performed and the liver was evaluated by palpation and intraoperative ultrasound. Two observers who were blinded to surgical results evaluated each MR sequence separately. The number of lesions considered highly suspicious for metastatic lesions were determined for each sequence and were compared to the results of surgery. The McNemar test was used to compare the outcomes of the different sequences. MR Imaging was unable to detect small (<5 mm) metastases discovered at surgery. The best non-contrast sequences for detecting metastases were the STIR with 42% sensitivity, 83% specificity and an overall accuracy of 56% and the T1W sequence (sensitivity 38%, specificity 100%, accuracy 57%), which were not significantly different (p > 0.4). The noncontrast T2W sequence had a sensitivity of 29% and a specificity of 77% with an overall accuracy of 46%. When all pre contrast scans were grouped together the common sensitivity was 42%, specificity was 77% and accuracy was 54%. The post-ferumoxide T2W scans had a sensitivity of 42%, specificity of 85%, and accuracy of 57%, but did not detect any additional lesions. There was no statistical difference between the pre- and post-contrast studies with regard to identifying patients with metastatic disease (p > 0.1). In conclusion, we found small hepatic metastases in patients with early signs of recurrent colorectal cancer are difficult to detect on MRI. Ferumoxide-enhanced MRI was unable to detect additional hepatic metastases and performed no better than unenhanced MRI in detecting small hepatic metastasis. (C) 2000 Elsevier Science Inc.

AB - The purpose of this study was to evaluate the value of Ferumoxide- enhanced magnetic resonance (MR) imaging in the detection of hepatic metastases in high-risk patients treated for colorectal cancer that have rising CEA. We used 19 patients treated previously for colorectal cancer with rising CEA levels underwent an unenhanced T1-weighted (T1W), T2-weighted (T2W), STIR, and Ferumoxide-enhanced hepatic MRI. Following these studies, a laparotomy was performed and the liver was evaluated by palpation and intraoperative ultrasound. Two observers who were blinded to surgical results evaluated each MR sequence separately. The number of lesions considered highly suspicious for metastatic lesions were determined for each sequence and were compared to the results of surgery. The McNemar test was used to compare the outcomes of the different sequences. MR Imaging was unable to detect small (<5 mm) metastases discovered at surgery. The best non-contrast sequences for detecting metastases were the STIR with 42% sensitivity, 83% specificity and an overall accuracy of 56% and the T1W sequence (sensitivity 38%, specificity 100%, accuracy 57%), which were not significantly different (p > 0.4). The noncontrast T2W sequence had a sensitivity of 29% and a specificity of 77% with an overall accuracy of 46%. When all pre contrast scans were grouped together the common sensitivity was 42%, specificity was 77% and accuracy was 54%. The post-ferumoxide T2W scans had a sensitivity of 42%, specificity of 85%, and accuracy of 57%, but did not detect any additional lesions. There was no statistical difference between the pre- and post-contrast studies with regard to identifying patients with metastatic disease (p > 0.1). In conclusion, we found small hepatic metastases in patients with early signs of recurrent colorectal cancer are difficult to detect on MRI. Ferumoxide-enhanced MRI was unable to detect additional hepatic metastases and performed no better than unenhanced MRI in detecting small hepatic metastasis. (C) 2000 Elsevier Science Inc.

KW - Ferumoxide

KW - Liver

KW - Metastases

UR - http://www.scopus.com/inward/record.url?scp=0034008285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034008285&partnerID=8YFLogxK

U2 - 10.1016/S0730-725X(99)00134-4

DO - 10.1016/S0730-725X(99)00134-4

M3 - Article

C2 - 10745140

AN - SCOPUS:0034008285

VL - 18

SP - 305

EP - 309

JO - Magnetic Resonance Imaging

JF - Magnetic Resonance Imaging

SN - 0730-725X

IS - 3

ER -