Similarly, one study of 12 patients with rectal cancer has been published (Koh et al., 2004). Appearances of 74 nodes on in vivo MRI were compared with histopathologic findings. Six lymph nodes contained metastases which demonstrated eccentric and uniform high signal intensity patterns of USPIO uptake, reporting a sensitivity and specificity of 67% and 96% respectively. An abstract presentation by Rasheed et al. (2006) of 13 patients with rectal cancer who underwent MRI before and 24 hours after intravenous infusion of USPIO contrast reported a good correlation between the histopathogical lymph nodes and the ones seen on USPIO-unenhanced MRI (r = 0.73; P = 0.005). Taking into account the recent study on the use of USPIO in gastric cancer (Tatsumi et al., 2006), in addition to published meta-analytical work, the pooled sensitivity and specificity of USPIO-enhanced MRI for the detection of lymph node metastases in the abdomen and pelvis would be 93% and 96% respectively (Figure 3.5).
Finally, we believe that novel 3D reconstruction techniques would be of particular help in displaying and analyzing the massive amount of high-resolution data. In this sense it should be feasible to display both normal and abnormal lymph nodes and their location with respect to important surgical landmarks
like vessels, obturator nerves, and ureters in 3D. In this respect, a Lymph Node Task Card is a works-in-progress post-processing package (Siemens Princeton, USA) allowing simultaneous viewing of 3D sequences in four segments, with in-line MIP and VRT capabilities for rendering datasets. In addition, automatic fusion of CTA and ferumoxtran-MRI data is possible with this tool (Figure 3.6). This allows a better detection by clinicians as to where the positive nodes are located and increases the precision in the planning of automated radiation oncology.
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