Korean J Radiol.  2008 Dec;9(6):510-519. 10.3348/kjr.2008.9.6.510.

Small Malignant Hepatic Tumor Detection in Gadolinium- and Ferucarbotran-Enhanced Magnetic Resonance Imaging: does Combining Ferucarbotran-Enhanced T2*-Weighted Gradient Echo and T2-Weighted Turbo Spin Echo Images have Additive Efficacy?

• Kim YK
• Lee YH
• Kwak HS
• Kim CS
• Han YM

• KMID: 1118872
• DOI: http://doi.org/10.3348/kjr.2008.9.6.510

Abstract

OBJECTIVE
To determine if a combination of ferucarbotran-enhanced T2*weighted-gradient echo (T2*W-GRE) and T2-weighted turbo spin echo (T2W-TSE) images in gadolinium- and ferucarbotran-enhanced MRI has additive efficacy compared to each image alone for detecting small (< or = 2.0 cm) hepatocellular carcinoma (HCC) lesions in a group of cirrhotic patients and metastases in a group of non-cirrhotic patients. MATERIALS AND METHODS: Two readers retrospectively analyzed gadolinium- and ferucarbotran-enhanced T2*W-GRE, T2W-TSE, and combined T2*W-GRE/T2W-TSE images of 119 patients with 157 HCCs and 32 patients with 98 metastases. The diagnostic accuracy and sensitivity for each image set and the combined set were evaluated using the alternative-free response receiver operating characteristic method. RESULTS: The mean area under the curve value of the combined set (0.966) tended to be better than that for each individual image set (T2W-TSE [0.910], T2*W-GRE [0.892]). Sensitivities in the combined set were higher than those in each individual image set for detecting HCC (mean, 93.0% versus 81.6% and 86.7%, respectively, p < 0.01). Sensitivities in the combined set and the T2W-TSE set were the same for detecting metastases, and both were higher than the sensitivity seen in the T2*W-GRE set (mean, 97.5% versus 85.2 %, p < 0.01). CONCLUSION: Combining ferucarbotran-enhanced T2*W-GRE and T2W-TSE has additive efficacy for detecting HCC in cirrhotic patients, but T2W-TSE is preferred for detecting metastases in non-cirrhotic patients.

Keyword

Liver, neoplasm; Liver, MR; Liver, cirrhosis; Magnetic resonance (MR), contrast media

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/*diagnosis
Contrast Media/*administration & dosage
Female
Gadolinium DTPA/*diagnostic use
Humans
Iron/*diagnostic use
Liver Neoplasms/*diagnosis/secondary
*Magnetic Resonance Imaging/methods
Male
Middle Aged
Observer Variation
Oxides/*diagnostic use
Predictive Value of Tests
Sensitivity and Specificity

Figure

• 

  Fig. 1 55-year-old man with well-differentiated hepatocellular carcinoma in subcapsular area of right hepatic lobe. A. Axial respiratory-triggered T2-weighted turbo spin echo (4200/76) imaging shows no hepatic mass. B. Axial arterial phase three-dimensional dynamic MRI after administration of gadopentetate dimeglumine (4.3/2.0) shows no detected lesion. C. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows high signal intensity nodule (arrow) in subcapsular area of liver, which was assigned confidence level of 4 by both observers. D. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) shows no definitive lesion (arrow) at same location as in A. This was assigned score of 1 and 2 by the two observers, respectively.

• 

  Fig. 2 50-year-old man with two hepatocellular carcinomas in right hepatic lobe. A. Axial arterial phase three-dimensional dynamic MRI after administration of gadopentetate dimeglumine (4.3/2.0) shows subtle small nodular enhancement (arrow) in subcapsular area of right hepatic lobe. Inferior margin of main mass located at slightly higher level is shown (small arrows). B. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows only main mass (arrows) in posterior portion of right hepatic lobe. Subcapsular lesion was assigned score of 1 by both observers using T2*-weighted gradient echo image set. C. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) shows definitive round hyperintense subcapsular mass (arrow) and main mass (small arrows), which were assigned confidence level of 4 by both observers.

• 

  Fig. 3 57-year-old man with surgically confirmed 0.4-cm liver metastasis from rectal cancer. A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) at medial margin of right hepatic lobe, which was missed by one observer and was assigned confidence level of 2 by other observer during image interpretation. B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 4 by both observers.

• 

  Fig. 4 55-year-old man with surgically confirmed 0.4-cm liver metastasis from colon cancer. A. Axial ferucarbotran-enhanced breath-hold T2*-weighted gradient echo imaging (180/12) shows irregular high signal intensity lesion (arrow) in inferior portion of right hepatic lobe. Both reviewers missed this lesion during image interpretation. B. Axial ferucarbotran-enhanced respiratory-triggered T2-weighted turbo spin echo imaging (4200/76) clearly shows small round hyperintense mass (arrow) at same location as in A. This was assigned score of 3 by both observers.

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