J Korean Soc Radiol.  2010 Dec;63(6):537-546.

Hepatic Angiomyolipoma: Dual-Contrast MRI Findings Using Superparamagnetic Iron Oxide (SPIO) and Gadolinium Agents

• Kim MU
• Kim SH
• Kim HC
• Lee JY
• Kim MA
• Han JK
• Choi BI

Abstract

PURPOSE
To analyze imaging findings of hepatic angiomyolipomas (AMLs) on dual-contrast MRI using superparamagnetic iron oxide (SPIO) and gadolinium (Gd) agents.
MATERIALS AND METHODS
Five histopathologically-proven hepatic AMLs were enrolled in this study. Patients underwent dual-contrast MRI using SPIO and Gd agents on a 3.0T unit and performed a qualitative analysis consisting of measuring the signal intensity (SI) of the lesion, presence of fat, hemorrhage, early draining vein, tortuous tumoral vessels, as well as capsule and enhancement patterns. The signal drop of the lesion on post-SPIO images was also assessed. For the quantitative analysis, relative signal decrease (RSD, %) was calculated.
RESULTS
The presence of fat was noted in three lesions. An early draining vein and prominent tortous tumoral vessels were depicted in four lesions. No lesion was found to have a capsule. Four lesions showed early wash-in and early wash-out enhancement patterns, while the remaining lesion depicted strong and persistent enhancement. On post-SPIO images, signal drop was noted in the two lesions with no fat within the lesion. Their RSD was 21.1% and 38.0%, respectively.
CONCLUSION
The presence of an early draining vein and tortuous tumoral vessels are characteristic dynamic enhanced MRI features of hepatic AMLs. In fat-deficient hepatic AMLs, the combination of dynamic enhanced MRI and SPIO-enhanced MRI might findings might increase the accuracy of making a correct diagnosis.

MeSH Terms

Angiomyolipoma
Ferric Compounds
Gadolinium
Hemorrhage
Humans
Iron
Liver
Veins
Ferric Compounds
Gadolinium
Iron

Figure

• 

  Fig. 1 A 23-year-old woman with a fat-rich hepatic angiomyolipoma (case 2). A. In the right hepatic lobe, a huge hypointense mass (arrows) is seen. In- (left) and opposed-phase (right) T1-weighted images demonstrate the presence of fat manifesting as a signal drop on an opposed-phase image. Note a high signal intensity foci (arrowheads) within the tumor, suggesting intratumoral hemorrhage. B. On post-SPIO and post-gadolinium (Gd-EOB-DTPA) arterial phase images, entangled feeding arteries (arrows) and engorged draining veins (arrowheads) are seen at the periphery of the tumor. Right (thin arrow) and middle (thin double arrow) hepatic veins are opacified, suggesting early draining veins. Note the presence of a non-opacified left hepatic vein (open arrow). C. On post-SPIO and post-gadolinium dynamic MR images, the tumor shows hypervascularity in the arterial phase (upper right) compared to a precontrast scan (upper left), and hypointensity on portal (lower left) or equilibrium (lower right) phases. D. Compared to pre-SPIO T2-weighted fast spin echo images (left), no signal drop is depicted on the post-SPIO T2-weighted images (right). This finding suggests no SPIO uptake by the tumor. Note the curvilinear signal void (arrows) indicating entangled vessels at the periphery of the tumor. E. The tumor shows a signal defect on the hepatobiliary phase image obtained 20 minutes after Gd-EOB-DTPA injection, suggesting no uptake of hepatocyte-specific contrast agent by the tumor. No capsule is observed around the tumor.

• 

  Fig. 2 A 61-year-old woman with fat-deficient hepatic angiomyolipoma (case 1). A. In segment V/VI of the liver, a 6.8-cm hypointense mass (arrows) is seen on in- (left) and opposed-phase (right) T1-weighted images. There is profound signal drop in the background liver but no signal drop of the tumor on an opposed-phase image. There is no hemorrhage within the tumor. B. On post-SPIO and post-gadolinium (Gd-BOPTA) arterial phase images, the curvilinear engorged draining vein (arrow) is depicted at the periphery of the tumor. Right hepatic vein (arrowhead) is strongly opacified compared to the middle (thin arrow) and left (thin double arrow) hepatic veins. This suggests that the right hepatic vein acts as an early draining vein. C. On post-SPIO and post-gadolinium dynamic MR images, the tumor shows strong hypervascularity on arterial phase (upper right) compared to a precontrast scan (upper left) and persistent enhancement on portal (lower left) or equilibrium (lower right) phases. D. Compared to the pre-SPIO T2-weighted fast spin echo image (left), prominent signal drop is noted on the post-SPIO T2-weighted image (right), suggesting that SPIO uptake by the tumor is due to a blood pooling effect. The mean signal intensity of the tumor on pre- and post-SPIO images was 158.3 and 125.0, respectively. Relative signal decrease was 21.1% in this case. Note linear signal void (arrows) indicating an entangled vessel in the tumor.

• 

  Fig. 3 A 64-year-old woman with a fat-deficient hepatic angiomyolipoma (case 3). A. On a precontrast T2-weighted fast spin echo image, the tumor (arrow) shows a bright high signal intensity. B. The posterior portion (double arrow) of the tumor (arrow) shows signal drop on post-SPIO T2-weighted image. The relative signal decrease of the lesion was 38.0%.

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