超小型超顺磁性氧化铁颗粒可增强MRI对头颈部淋巴结转移的评估价值  

Ultra-small superparamagnetic iron oxide particles enhance MRI diagnosis of lymph node metastasis of the head and neck

作　　者：李文晋[1] 牛金亮[1] 朱莉[1] 王涛[1] 王瑜[1] Li Wenjin;Niu Jinliang;Zhu Li;Wang Tao;Wang Yu(Second Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi Province,China)

机构地区：[1]山西医科大学第二医院,山西省太原市030001

出　　处：《中国组织工程研究》2018年第34期5518-5525,共8页Chinese Journal of Tissue Engineering Research

基　　金：山西省卫生厅科技攻关计划项目(20100141);山西省基础研究青年科技研究基金项目(2011021035-4);山西省研究生优秀创新项目(20093066);山西医科大学第二医院博士启动基金(2013-6);山西医科大学第二医院教学基金(201603-5);山西省教育厅高等学校科技创新项目(20141105);山西省留学办山西省回国留学人员科研资助项目(2016-122);山西省人社厅山西省留学回国人员科技活动项目择优资助经费(晋财社<2017>19号)~~

摘　　要：背景:研究表明超小型超顺磁性氧化铁颗粒(ultrasmall superparamagnetic iron oxide particles,USPIO)增强扫描提高了盆腔、乳腺、胸部恶性肿瘤的恶性淋巴结检测的特异性和敏感性,但关于USPIO在头颈部肿瘤颈部淋巴结转移的研究国内外文献报道较少。目的:建立头颈部淋巴结转移的动物模型,分析淋巴结转移USPIO增强扫描的MRI表现,探讨USPIO在诊断头颈部淋巴结转移中的临床应用价值。方法:建立20只头颈部肿瘤淋巴结转移模型兔。建模4周后,行MRI平扫,耳缘静脉注射90μmol Fe/kg(约4 mg/kg)新型MR对比剂USPIO,于注射前、注射后24 h行MRI扫描。扫描后取出头颈部淋巴结,进行组织病理学苏木精-伊红染色、普鲁士蓝染色,确定淋巴结的性质,定性及定量分析不同MRI检查方法头颈部转移淋巴结的特点,比较MRI平扫及新型MR对比剂USPIO增强扫描鉴别兔VX2瘤株头颈部肿瘤转移和未转移淋巴结的能力。结果与结论:(1)20只兔子共分离出57个淋巴结,其中25个病理检测证实淋巴结转移,腮腺淋巴结发生转移的有19个,颌下淋巴结发生转移的有6个。病理学证实4个转移淋巴结皮质浸润、3个髓质浸润及10个皮髓质均浸润;(2)MRI平扫13枚转移的淋巴结为真阳性,真阳性率为52%(13/25):假阳性为10枚,假阳性率为40%(10/25);MRI诊断未转移淋巴结34枚,病理学阴性淋巴结32枚,真阴性率为69%(22/32),假阴性率为38%(12/32);(3)新型MR对比剂USPIO增强扫描21枚淋巴结经病理学证实淋巴结转移,真阳性率为84%(21/25),假阳性率为8%(2/25),MRI诊断未转移淋巴结34枚,真阴性率为94%(30/32),假阴性率为13%(4/32);(4)定量分析未转移淋巴结SNR=-57.20±16.03,转移淋巴SNR=-16.20±5.03,增强扫描前后SNR差值具有显著性意义(P <0.05);(5)结果证实,新型MR对比剂USPIO增强扫描和常规MRI比较的优势是新型MR对比剂USPIO增强扫描是诊断淋巴结转移的新方法,诊断准确率高。BACKGROUND:Studies have shown that ultra-small superparamagnetic iron oxide particles(USPIO)enhanced scanning improves the specificity and sensitivity of malignant lymph node detection in pelvic,breast,and chest malignancies.However,USPIO is rarely reported in the literature addressing lymph node metastasis of the head and neck.OBJECTIVE:To establish an animal model of lymph node metastasis of the head and neck,to analyze USPIO enhanced MRI performance of the lymph metastasis,and to explore the clinical value of USPIO in the lymph node metastasis of the head and neck.METHODS:Animal models of lymph node metastasis of the head and neck were made in 20 healthy New Zealand rabbits.At 4 weeks after modeling,a plain MRI scan was performed.A novel MR contrast agent,USPIO,was injected into the rabbit ear vein at 90μmol Fe/kg(about 4 mg/kg).MRI scan was performed before and 24 hours after injection.After scanning,the head and neck lymph nodes were taken out,and hematoxylin-eosin staining and Prussian blue staining were performed to determine the nature of lymph nodes.The characteristics of head and neck metastatic lymph nodes in different MRI examinations were qualitatively and quantitatively analyzed.MRI plain scan and USPIO enhanced scan were used to identify the ability of rabbit VX2 tumor metastasis and non-metastatic lymph nodes in the head and neck.RESULTS AND CONCLUSION:(1)Fifty-seven lymph nodes were isolated from 20 rabbits,25 of which were confirmed to be metastatic by pathological examination(19 parotid lymph nodes and 6 submandibular lymph nodes).Pathological findings confirmed cortex invasion in 4 metastatic lymph nodes,medullary infiltration in 3 metastatic lymph nodes,and cortex and medulla infiltration in 10 metastatic lymph nodes.(2)The plain MRI scan detected 13 metastatic lymph nodes were true positive and the positive rate was 52%(13/25);10 lymph nodes were false positive and the false-positive rate was 40%(10/25).MRI scans showed 34 lymph nodes without metastasis,and 32 pathology-negative lymph nodes

关 键 词：超小型超顺磁性氧化铁颗粒 VX2瘤株 头颈部 兔 腮腺淋巴结转移 颌下淋巴结转移 MRI平扫 病理学染色 诊断准确率 超小型超顺磁性氧化铁颗粒 VX2瘤株 头颈部 兔 腮腺淋巴结转移 颌下淋巴结转移 MRI平扫 病理学染色 诊断准确率 

分 类 号：R318[医药卫生—生物医学工程]