In 58 patients with proven bladder cancer, MRI performed before and after injection of ferumoxtran-10 was compared with histopathologic results in surgically removed lymph nodes (Deserno et al., 2004). One hundred and seventy two nodes imaged after injection of ferumoxtran-10 were matched and correlated with the results of node dissection. Of these, 122 were benign and 50 were malignant. With nodal size and shape criteria, the accuracy, sensitivity, specificity and positive and negative predictive values on pre-contrast images were 92%, 76%, 99%, 97%, and 91%, respectively; the corresponding values on post-contrast images were 95%, 96%, 95%, 89%, and 98%. In the depiction of pelvic metastases, sensitivity and negative predictive value significantly improved on post-contrast images compared with those obtained pre-contrast, from 76% to 96% (P < 0.001) and from 91% to 98% (P < 0.01), respectively. At post-contrast imaging, metastases (4-9 mm) were prospectively found in 10 of 12 normal-sized nodes (<10 mm); these metastases were not detected on pre-contrast images. Post-contrast images also showed lymph nodes that were missed at pelvic node dissection in two patients. Thus ferumoxtran-10-enhanced MRI significantly improves nodal staging in patients with bladder cancer by depicting metastases even in normal-sized lymph nodes.
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