Combined MR Lymphangiography and MR Imaging—Guided Needle Localization of Sentinel Lymph Nodes Using Gadomer-17

Abstract

OBJECTIVE. The goals of our study were to determine the technical feasibility of dynamic MR lymphangiography for detecting sentinel lymph nodes using Gadomer-17 contrast material to compare these results to the clinically standardized blue dye contrast agent, and to show MR imaging—guided needle localization marking of the sentinel nodes. MATERIALS AND METHODS. Six anesthetized swine underwent MR imaging before and for 1 hr after interstitial injection of Gadomer-17 in the posterior tongue and intradermally in the stifle (knee). Using MR imaging guidance, we percutaneously placed a histology needle into the sentinel node or nodes. A standardized intraoperative sentinel node detection procedure was then performed using isosulfan blue contrast agent. Sentinel nodes identified on the MR images were compared with and matched to those identified by biopsy needle localization and the isosulfan blue contrast agent. RESULTS. Interstitial and intradermal injection of Gadomer-17 resulted in a lasting, increased MR signal in the regional lymph nodes. Seven sentinel nodes were identified in both the neck and the groin, with one pig showing two sentinel nodes in the neck and another showing two sentinel nodes in the groin. In all cases, the isosulfan blue contrast agent agreed with the location of the sentinel node determined by Gadomer-17 and marked with the needle. CONCLUSION. In this large animal model, dynamic MR angiography of sentinel lymph nodes is technically feasible using a contrast agent (Gadomer-17) and can be easily combined with MR imaging—guided needle localization.