Bob Cobb's trip to NL for a Combidex Scan

In August, 2006, I traveled to Nijmegen, Netherlands, to undergo two medical diagnostic scans, one of which is currently available only in Europe.

I had an 18F-Fluoride PET/CT bone scan, which is reported to be a much more sensitive scan for the determination of bone metastases. This scan is reportedly also available in limited locations in the U.S.

My primary reason to go to Nijmegen was to consult with Dr. J. Barentsz and to have the Combidex MRI at 3.0T scan performed. Dr. Barentsz is a highly-trained specialist in imaging research. The Combidex MRI is an investigational procedure that is used to determine the presence of cancerous cells in the lymph node system. It can be used to detect such cells as small as 3 mm in size.

The Combidex MRI procedure involves the infusion of iron oxide nanoparticles (a nanometer is one billionth of a meter) into the body. The infused solution looks like non-carbonated cola soft drink and is filtered through a 2 nanometer filter to remove any larger iron oxide particles. The following day, allowing for the uptake of the iron oxide into the lymph node tissues, the actual scan is performed. Currently, the Combidex MRI uses a 3.0T rather than more common 1.5T strength magnet. This permits enhanced accuracy and definition of the scanned images.

Prior to the scan, if the patient does not have any medical issues involving glaucoma, a drug is injected to quiet the GI tract, in order to obtain scans of optimal resolution and focus.

As far as the patient experience, the MRI scan is like any I have previously experienced. The patient lies, unmoving, on a platform that is placed within the tunnel of the MRI machine. Scans are made, of varying duration, accompanied by rather loud and irregular noises from the equipment. In this setting, I was given a headset, for communication purposes, and to reduce the noise level There was a "boom box" in the room, to provide some environmental distraction, during the approximately one hour procedure. I requested that they play Vivaldi's "Four Seasons" as for me, it is both relaxing and engaging.

During certain portions of the procedures, the patient is asked to hold his breath, to permit sharp scans to be made, without any distortion due to external or internal body movements.

Once the scan was completed, after a short wait, I had a consultation with Dr. Barentsz regarding the results. In my case there were two small spots in the lymph node system which were deemed "equivocal". Dr. Barentsz indicated that he felt that these could be deemed "non-metastatic", but should be monitored in the future, when ongoing diagnostics are performed.

I received a CD with copies of all my scans, including a virtual 3-dimensional model of my lymph node system which can be rotated to view any areas of interest.

I felt very well cared for during the whole process at Nijmegen and am glad that I was able to use the Combidex MRI and 18F-Fluoride PET/CT scans to assist in determining my medical status, prior to the development of a treatment plan.

Currently, the EU regulatory board which approves medical procedures has been supplied medical data regarding the Combidex MRI, with the goal of obtaining approval for its use in Europe. If that is obtained, an application will be submitted to the FDA for similar approval. Dr. Barentsz believes that in the future, the Combidex scan will be a universal diagnostic tool for the determination of lymph node status.

This scan can be used similarly for liver, pancreatic, prostate and other cancerous conditions. It is unsuitable for the use in head/neck diagnostics, due to the complexity of the anatomy in those regions.