Detection of lymph node metastases in pancreatic, duodenal, or periampullary cancer

In patients with pancreatic, duodenal, or periampullary cancer lymph node metastases are an important prognostic factor for a decreased survival. But unfortunately with current diagnostic techniques these lymph node metastases cannot be reliably detected.

Researchers Geke Litjens and John Hermans from the imaging department, in collaboration with colleagues from their department and the surgery, pathology, and gastroenterology department, have investigated an iron based MRI contrast-agent to improve detection of lymph node metastases. Their results are published in European Radiology on 22 June 2024.

In a prospective study, patients with pancreatic, duodenal or periampullary cancer that were planned for surgery were included. Preoperatively, an MRI enhanced with Ferumoxtran, an intravenously administered contrast agent containing ultra-small super paramagnetic iron oxide (USPIO) particles was performed. When injected into the bloodstream, these iron particles are taken up by macrophages and collect in healthy lymph nodes. The iron disrupts the MRI’s magnetic field, making healthy nodes appear darker.

The MRI scans of 18 patients were analyzed by two radiologists and lymph nodes seen on this MRI were scored based on their appearance on MRI. The lymph nodes seen on MRI were matched to the lymph nodes found in the resection specimen by the pathologist. The sensitivity and specificity of the USPIO-enhanced MRI to detect lymph node metastases was 83% and 92%, respectively.

The results of their study are promising and have the potential to improve preoperative detection and localization of lymph node metastases in patients with pancreatic, duodenal, or periampullary cancer. Although, the technique needs further refinement and validation before it can be implemented in daily clinical practice, it holds the promise of enabling more personalized and effective treatment strategies, eventually improving patient outcome in these challenging cancers. The researchers of the Imaging department aspire to continue to study this technique for these and other cancer types.

Publication

Geke Litjens, Atsushi Nakamoto, Lodewijk A. A. Brosens, Marnix C. Maas, Tom W. J. Scheenen, Patrik Zámecnik, Erwin J. M. van Geenen, Mathias Prokop, Kees J. H. M. van Laarhoven & John J. Hermans. Ferumoxtran-10-enhanced MRI for pre-operative metastatic lymph node detection in pancreatic, duodenal, or periampullary adenocarcinoma. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10838-w