Publications by authors named "Ansje Fortuin"

Background: Accurate detection of lymph node (LN) metastases in prostate cancer (PCa) is a challenging but crucial step for disease staging. Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging (MRI) enables distinction between healthy LNs and nodes suspicious for harboring metastases. When combined with MRI at an ultra-high magnetic field, an unprecedented spatial resolution can be exploited to visualize these LNs.

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Article Synopsis
  • A study aimed to define a baseline for pelvic lymph nodes using advanced 7 Tesla MRI to improve validation and assessment of lymph node dissections in pelvic cancers.
  • The research involved imaging 11 healthy volunteers, resulting in the detection of 564 lymph nodes, with an average of 51.3 nodes per person and a significant portion being small (≤2 mm in diameter).
  • Findings indicate substantial variation in the number of visible lymph nodes among individuals, but a consistent size distribution, suggesting that the many small nodes pose challenges for effective surgical removal and detection of metastases.
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Purpose: To evaluate the technical feasibility of high-resolution USPIO-enhanced magnetic resonance imaging of pelvic lymph nodes (LNs) at ultrahigh magnetic field strength.

Materials And Methods: The ethics review board approved this study and written informed consent was obtained from all patients. Three patients with rectal cancer and three selected patients with (recurrent) prostate cancer were examined at 7-T 24-36 h after intravenous ferumoxtran-10 administration; rectal cancer patients also received a 3-T MRI.

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In the past 15 years, encouraging clinical results for the detection of small lymph node metastases was obtained by the use of Combidex-enhanced MRI (CEM, also known as magnetic resonance lymphography). Withdrawal of the European Medicines Agency approval application by the manufacturer made it impossible for patients to benefit from this agent; a loss, especially for men with prostate cancer. Current conventional imaging techniques are not as accurate as CEM is, thus a surgical diagnostic exploration (extended lymph node dissection) is still the preferred technique to evaluate the lymph nodes, resulting in peri- and postoperative complications.

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Objectives: The key to MR lymphography is suppression of T2* MR signal in normal lymph nodes, while retaining high signal in metastatic nodes. Our objective is to quantitatively compare the ability of ferumoxtran-10 and ferumoxytol to suppress the MR signal in normal pelvic lymph nodes.

Methods: In 2010, a set of consecutive patients who underwent intravenous MR Lymphography (MRL) were included.

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Article Synopsis
  • A new method using ultrahigh-field MRI enables improved imaging of pelvic lymph node (PLN) metastases, which are often very small and difficult to detect.
  • Researchers tested a specific multi-gradient echo and gradient echo sequence on a 7 Tesla MRI system with six healthy volunteers, aiming to enhance image quality.
  • The results showed successful detection of lymph nodes as small as 1.5 mm, demonstrating high-resolution imaging capabilities that may aid in identifying small PLN metastases in the future.
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Nodal staging in prostate cancer is suboptimal both with respect to current imaging modalities and pelvic lymph node dissection, and thus other techniques are being explored. Lymphotropic nanoparticle-enhanced MRI, also called magnetic resonance lymphography (MRL), is a technique that has shown high sensitivity (65-92 %) and excellent specificity (93-98 %) in detecting prostate cancer lymph node metastases. This technique aids in the detection of metastases in non-enlarged small nodes.

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Knowledge on lymph node metastases is crucial for the prognosis and treatment of prostate cancer patients. Conventional anatomic imaging often fails to differentiate benign from metastatic lymph nodes. Pelvic lymph node dissection is an invasive technique and underestimates the extent of lymph node metastases.

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Purpose: To investigate the pattern of lymph node spread on magnetic resonance lymphography (MRL) in prostate cancer patients and compare this pattern to the clinical target volume for elective pelvis irradiation as defined by the radiation therapy oncology group (RTOG-CTV).

Methods And Materials: The charts of 60 intermediate and high risk prostate cancer patients with non-enlarged positive lymph nodes on MRL were reviewed. Positive lymph nodes were assigned to a lymph node region according to the guidelines for delineation of the RTOG-CTV.

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Purpose: To determine the clinical value of two novel molecular imaging techniques: (11)C-choline positron emission tomography (PET)/computed tomography (CT) and ferumoxtran-10 enhanced magnetic resonance imaging (magnetic resonance lymphography [MRL]) for lymph node (LN) treatment in prostate cancer (PCa) patients. Therefore, we evaluated the ability of PET/CT and MRL to assess the number, size, and location of LN metastases in patients with primary or recurrent PCa.

Methods And Materials: A total of 29 patients underwent MRL and PET/CT for LN evaluation.

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Purpose: To compare the nodal risk formula (NRF) as a predictor for lymph node (LN) metastasis in patients with prostate cancer with magnetic resonance lymphography (MRL) using Ultrasmall Super-Paramagnetic particles of Iron Oxide (USPIO) and with histology as gold standard.

Methods And Materials: Logistic regression analysis was performed with the results of histopathological evaluation of the LN as dependent variable and the nodal risk according to the NRF and the result of MRL as independent input variables. Receiver operating characteristic (ROC) analysis was performed to assess the performance of the models.

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