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Susceptibility Perturbation MRI Maps Tumor Infiltration into Mesorectal Lymph Nodes.

dc.contributor.authorSantiago, I
dc.contributor.authorSantinha, J
dc.contributor.authorIanus, A
dc.contributor.authorGalzerano, A
dc.contributor.authorManso, RT, et al.
dc.date.accessioned2019-05-20T15:27:20Z
dc.date.available2019-05-20T15:27:20Z
dc.date.issued2019
dc.description.abstractNoninvasive characterization of lymph node involvement in cancer is an enduring onerous challenge. In rectal cancer, pathologic lymph node status constitutes the most important determinant of local recurrence and overall survival, and patients with involved lymph nodes may benefit from preoperative chemo and/or radiotherapy. However, knowledge of lymph node status before surgery is currently hampered by limited imaging accuracy. Here, we introduce Susceptibility-Perturbation MRI (SPI) as a novel source of contrast to map malignant infiltration into mesorectal lymph nodes. SPI involves multigradient echo (MGE) signal decays presenting a nonmonoexponential nature, which we show is sensitive to the underlying microstructure via susceptibility perturbations. Using numerical simulations, we predicted that the large cell morphology and the high cellularity of tumor within affected mesorectal lymph nodes would induce signature SPI decays. We validated this prediction in mesorectal lymph nodes excised from total mesorectal excision specimens of patients with rectal cancer using ultrahigh field (16.4 T) MRI. SPI signals distinguished benign from malignant nodal tissue, both qualitatively and quantitatively, and our histologic analyses confirmed cellularity and cell size were the likely underlying sources for the differences observed. SPI was then adapted to a clinical 1.5 T scanner, added to patients' staging protocol, and compared with conventional assessment by two expert radiologists. Nonmonoexponential decays, similar to those observed in the ex vivo study, were demonstrated, and SPI classified lymph nodes more accurately than standard high-resolution T2-weighted imaging assessment. These findings suggest this simple, yet highly informative, method can improve rectal cancer patient selection for neoadjuvant therapy. SIGNIFICANCE: These findings introduce an MRI methodology tailored to detect magnetic susceptibility perturbations induced by subtle alterations in tissue microstructure.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationCancer Res. 2019 May 1;79(9):2435-2444.pt_PT
dc.identifier.doi10.1158/0008-5472.CAN-18-3682pt_PT
dc.identifier.issn1538-7445
dc.identifier.urihttp://hdl.handle.net/10400.10/2259
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Association for Cancer Researchpt_PT
dc.relation.publisherversionhttp://cancerres.aacrjournals.org/content/canres/early/2019/03/19/0008-5472.CAN-18-3682.full.pdfpt_PT
dc.subjectLymph nodespt_PT
dc.subjectRectal neoplasmspt_PT
dc.subjectMagnetic resonance imagingpt_PT
dc.titleSusceptibility Perturbation MRI Maps Tumor Infiltration into Mesorectal Lymph Nodes.pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceBaltimore, Md.pt_PT
oaire.citation.titleCancer Researchpt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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