The determination of lymph node involvement (nodal staging) is mandatory when investigating patients with malignancy (1-3). Standard cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) apply unreliable indices such as nodal size and other morphological criteria to distinguish benign from malignant lymph nodes (4-6). This is principally because normal-sized nodes may contain microscopic metastatic disease and enlarged nodes can be reactive in nature; furthermore, it has been repeatedly shown that signal intensity on MR images as well as the presence of gadolinium enhancement is unreliable when trying to distinguish normal nodes from cancerous nodes (7,8).

Ferumoxtran-10 enhanced MRI (MR lymphangiography) has emerged as an extremely accurate tool to differentiate benign from malignant lymph nodes (9-11). This technique has been shown to accurately detect microscopic malignant deposits within normal-sized lymph nodes at a number of anatomical sites including the pelvis (9), axilla, head, and neck region. However, optimal MR scanning technique is critical to the successful interpretation of this novel imaging tool (12); in this chapter, we discuss strategies to optimize the technique of ferumoxtran-10-enhanced MR lymphangiography.

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